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Results for “Truth Disclosure”

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PubMed1993

An associateship--"the beginning".

Associateships can be successful and profitable. However, prudent business principles must be followed by both parties. The relationship of two professionals is essentially different from other employee/employer situations, particularly so if the agenda of the principle practitioner is more complex. No matter what the level of complexity of the associate agreement, the will to agree based on full and complete disclosure is much more important than the adherence to some letter of the law. Most provisions of associate agreements are difficult, if not impossible, to enforce. Both sides are then at risk. The clearest form of protection is a complete and unreserved sharing of the requirements, expectations and intent of the relationship.

Humans↗
PubMed1996

The personal is the organizational in the ethics of hospital social workers.

Understanding the social context of clinical ethics is vital for making ethical discourse central in professional practice and for preventing harm. In this paper, we present findings about clinical ethics from in-depth interviews and consultation with 7 members of a hospital social work department. Workers gave different accounts of ethical dilemmas and resources for ethical decision making than did their managers, whereas workers and managers agreed on core-guiding ethical principles and on ideal situations for ethical discourse. We discuss the research team's initial interpretations, the relevance of the extant ethics literature to organizational structures and dynamics, and alternative perspectives on clinical ethics.

Administrative Personnel↗
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↗
PubMed1998

Disclosure of disability: exploring the perspective of parents.

OBJECTIVE: To explore the perspective of parents with regard to disclosure of disability and early follow-up care. DESIGN: The research approach was hermeneutic phenomenology. Data were collected using focused interviews that were audio-taped, transcribed and interpreted. SETTING: Scotland. PARTICIPANTS: The parents of 63 children born with a congenital limb deficiency. FINDINGS: The findings demonstrate the complexity and variability in parental response. Additionally, what is shown is that disclosure was often handled poorly and that the support offered during the stay in the maternity unit was frequently inadequate. CONCLUSION: In order to handle disclosure effectively, health professionals require appropriate education and training and it is recommended that innovative ways of encouraging discussion and debate are sought.

Adaptation, Psychological↗
PubMed2026

Pathways of onward HIV disclosure in relationships among young people living with vertically acquired HIV receiving antiretroviral therapy: A qualitative analysis from the BREATHER Plus trial, South Africa.

For young people living with HIV (YPLHIV) navigating their status since birth, managing onward disclosure of a potentially stigmatising condition in relationships is challenging, and may or may not lead to social support, with implications for wellbeing. In a clinical trial setting in KwaZulu-Natal, South Africa, we investigate how young people living with vertically acquired HIV navigate onward disclosure. Data were from the qualitative component of the BREATHER Plus randomised controlled trial evaluating the efficacy, safety and acceptability of short-cycle dolutegravir/tenofovir-based triple antiretroviral therapy (ART) in young people aged 12-19 years. We analyse data on 35 participants receiving ART engaged in clinical trials at the research site: 29 in longitudinal in-depth interviews (IDIs) and 12 across three focus group discussions (FGDs), including 6 in IDIs and FGDs. The Disclosure Processes Model was applied in the thematic analysis. Pre-disclosure was characterised by social assessments of potential confidants. During disclosure, reciprocal vulnerability and partial information-sharing were employed. Post-disclosure processes entailed linear and non-linear feedback trajectories, impacting future disclosures. The findings show that the study cohort of young people receiving ART navigated many bidirectional disclosure pathways to maintain social connections in relationships, and counselling guidelines need to be responsive to this.

Humans↗
PubMed2003

Fixing past mistakes. Answers to questions about reviews, refunds, disclosures.

A medical group must address practical and legal issues when it discovers improper payments, billing mistakes or alleged misconduct. Its response has a significant impact on how the charges are resolved. A group and its providers can come under fraud and abuse investigations, whistle-blower allegations and Medicare payment reviews. Many questions arise in response to billing errors or allegations of misconduct.

Financial Audit↗
PubMed2003

Changes in levels of hope after diagnostic disclosure among Taiwanese patients with cancer.

The purposes of this study were to explore the extent to which the practice of disclosing cancer diagnoses to patients is used in Taiwan, to examine the relation between cancer diagnosis disclosure and levels of hope, and to investigate the relation between length of time since diagnosis and levels of hope. The participants in this study were 124 Taiwanese oncology inpatients and outpatients. Of these patients, 79% were informed of their cancer diagnosis. The informed patients reported significantly higher levels of hope than those who were not informed. Finally, patient levels of hope decreased as the time between cancer diagnosis and disclosure increased. The implications of this study are discussed in terms of cancer disclosure practice and enhancement of levels of hope for Taiwanese patients with cancer.

Adaptation, Psychological↗
PubMed2004

The attitudes of cancer patients and their families toward the disclosure of terminal illness.

PURPOSE: To ascertain the attitude of cancer patients and their families toward disclosure of terminal illness to the patient. PATIENTS AND METHODS: We constructed a questionnaire that included demographic and clinical information and delivered it to 758 consecutive individuals (433 cancer patients and 325 families that have a relative with cancer) at seven university hospitals and one national cancer center in Korea. RESULTS: 380 cancer patients and one member from each of 281 families that have a relative with cancer completed the questionnaire. Cancer patients were more likely than family members to believe that patients should be informed of the terminal illness (96.1% v 76.9%; P <.001). Fifty percent of the family members and 78.3% of the patients thought that the doctor in charge should be the one who informs the patient. Additionally, 71.7% of the patients and 43.6% of the family members thought that patients should be informed immediately after the diagnosis. Stepwise multiple logistic regression indicated that the patient group was more likely than the family group to want the patient to be informed of the terminal illness (odds ratio [OR], 9.76; 95% CI, 4.31 to 22.14), by the doctor (OR, 4.00; 95% CI, 2.61 to 6.11), and immediately after the diagnosis (OR, 3.64; 95% CI, 2.45 to 5.41). CONCLUSION: Our findings indicated that most cancer patients want to be informed if their illness is terminal, and physicians should realize that the patient and the family unit may differ in their attitude toward such a disclosure. Our results also reflect the importance of how information is given to the patient.

Adult↗
PubMed1993

How should radiologists reply when patients ask about their diagnoses? A survey of radiologists' and clinicians' preferences.

Radiologists must consider several factors when asked by a patient to disclose the results of a radiologic examination. This study represents a survey of radiologists' and clinicians' opinions regarding disclosure of information to patients by the radiologist. A clearer understanding of the preferences of radiologists and clinicians may serve to improve communication and enhance cooperation between the two groups, with the ultimate result being improved patient care.

Attitude of Health Personnel↗
PubMed1997

Epidural analgesia for labour and delivery: informed consent issues.

OBJECTIVE: Many anaesthetists believe that informed consent for epidural analgesia during labour is inadequate. Patients are perceived to be poorly informed and unable to cope with the information given during labour for informed consent. We reviewed these two hypotheses: A) to define complications for which patients want clear information: B) to quantify the influence of pain, anxiety, opioid premedication, and the importance of level of education, on a patient's level of satisfaction with regard to the consent process: and C) to assess how satisfactory epidural pain relief correlates with satisfaction with the consent process. METHODS: Sixty patients were surveyed during the first two months after vaginal delivery by two interviewers. Questions related to demographics, severity of labour pain, level of satisfaction with the epidural anaesthetic, risk of complications and satisfaction with information received were either categorical or scored on a scale from 0 to 10. RESULTS: All epidural related complications were considered important to disclose (8.4/10). The level of satisfaction with the consent process was 8.1/10. Patient satisfaction was not affected by opioid premedication, anxiety, pain score, education group or level of pain relief. CONCLUSION: Patients indicated they should be informed of all possible complications associated with epidural analgesia, regardless of severity or risk. In contrast to reports in the literature, non disclosure of serious risks during labour was not acceptable to parturients.

Adult↗
PubMed2006

Attitudes toward disease and prognosis disclosure and decision making for terminally ill patients in Japan, based on a nationwide random sampling survey of the general population and medical practitioners.

OBJECTIVE: Employing a nationwide cross-sectional survey, we investigated the Japanese general population's attitudes toward disease and prognosis disclosure and related factors. Furthermore, we investigated Japanese medical practitioners' attitudes toward disease and prognosis disclosure for patients and decision making. METHODS: A nationwide anonymous questionnaire survey was conducted. A total of 5000 individuals were randomly sampled from the general population and 3104 physicians and 6059 nurses were randomly sampled in Japan. RESULTS: Finally, 2422 people from the general population (response rate, 48%), 1577 physicians (51%), and 3361 nurses (56%) returned questionnaires. Among the general population, 73% of participants answered that they "want to know" about their disease and prognosis when in an incurable disease state. Ninety percent desired direct disclosure and 8% disclosure through their family. However, few medical practitioners answered "patient himself" (physician 3%, nurses 4%) as the person whom they would primarily notify about the disease and prognosis when in charge of a patient with an incurable disease. On the other hand, physicians answered "family" most frequently (59%), whereas nurses most commonly responded, "depends on patient's condition" (63%). SIGNIFICANCE OF RESEARCH: Several detailed analyses of factors associated with prognosis disclosure were conducted. Japanese physicians need to carefully communicate with the patients individually about whether direct disclosure or disclosure primarily to the family is preferred.

Adult↗
PubMed1995

Communication in orthodontic treatment planning: bioethical and informed consent issues.

Orthodontic treatment planning is an interactive process in which the patient or parent and the orthodontist serve as co-decision makers. As in most partnerships, there is a natural tension between the orthodontist and the patient because of differences in their frames of reference. The orthodontist generally is influenced more by the objective findings (the problem list), whereas patients are guided more by subjective issues related to their perceived needs, desires, and values. The art of careful probing and listening to the patient as part of the treatment planning process is an essential skill. One of the most difficult situations in contemporary orthodontics is presented by the patient with a jaw discrepancy for which the alternative treatments are orthodontic camouflage through dental compensation or surgical-orthodontic correction. Computer imaging to simulate the probable treatment outcomes can facilitate communication about these alternatives by eliminating misconceptions. Full disclosure and the consideration of all viable treatment alternatives have great benefits from a risk management standpoint, in addition to their bioethical merits.

Adolescent↗
PubMed1989

Breath analysis and self-reports as measures of alcohol-related emergency room admissions.

This study reports breath-analyzer readings and self-reports as measures of alcohol-related admission to the emergency room of San Francisco General Hospital. A 20% probability sample of patients admitted during a 60-day period was breath analyzed and interviewed. Interviews and breath samples were obtained on 75% of the sample of 2,516 patients. Twice the proportion of injury patients compared to noninjury patients had positive admission breath samples and reported drinking prior to the event. Alcohol involvement reached 41% for self-reports among injured men and over half of both men and women injured in fights or assaults reported drinking prior to the event. Self-reported alcohol use was found to be a valid measure of alcohol consumption when compared to breath-analyzer readings for the same individuals. Emergency room patients may be more likely than others to provide accurate reports of alcohol consumption if they feel that disclosure of amount and timing of drinking prior to an injury or illness could be important in their care. The data suggest that self-reports when used in conjunction with a quantifiable estimate of blood alcohol may be an appropriate method of ascertaining alcohol's involvement in emergency room cases.

Adult↗
PubMed1998

Cultural influences on medical disclosure.

Personal freedom and individualism are highly valued in Anglo-American culture and consequently in healthcare. However, not all cultures recognize the value of these principles. Healthcare can be compromised when the patient's cultural context differs from that of the clinician. Culture and its influences on the disclosure of health-related information are described. Self-determination from an historical perspective, the role of the family, and a deeper understanding of paternalism as they relate to cultural issues are illustrated through a case study. Suggestions for creating a culturally relevant healthcare practice is presented.

Attitude to Health↗
PubMed1998

Informed consent to medical treatment--the Israeli experience.

The ideological foundation of the doctrine of "informed consent" is rooted in the concept of personal freedom and freedom of choice. The concept of individual autonomy is represented by the "reasonable patient" standard which requires the disclosure of all information which a reasonable person in the position of the patient would need in order to make a rational decision regarding a proposed medical treatment. This attitude, however, conflicts with the traditional paternalism which is reflected in the "reasonable physician" standard, that is that a doctor must disclose that medical information which a rational doctor would relate to a patient in order to receive his consent. The enactment of the Patients' Rights Law in Israel in 1996 was an essential turning point in Israeli medical law. Section 13 of the new law explicitly establishes the requirement of informed consent and the details which a doctor must relate to a patient in order to reach the said agreement. Nevertheless, the law does not state the standard according to which it should be assessed whether the disclosure was proper. In a recent decision (C.A. 434/94 Shai Berman et al. v. Mor--the Institute for Medical Information, Ltd.) the Israeli Supreme Court took a step forward and determined that the duty to inform a patient will be judged by recognised criteria of negligence as they apply to the merits of each case.

Emergencies↗
PubMed2003

[Psychiatrists and the pharmaceutical industry].

Relationships between psychiatrists and the pharmaceutical industry have increased in frequency and intensity, both on the individual level and particularly on the institutional level. They extend from necessary and desirable cooperation to questionable practices and to unacceptable misconduct. Especially the latter has provoked a lively discussion and has initiated recommendations as well as guidelines. Their aim is to safeguard the integrity of physicians as well as the industry and to avoid endangering the relationship between the physician and the patient. They will do this by establishing clear norms, unequivocal documentation, and disclosure of relevant relationships in order to build up more mutual trust including that of the public. Based on a detailed review of the literature, 27 recommendations are put forward for discussion. Psychiatric associations should develop explicit guidelines for the relationships between psychiatrists and the pharmaceutical industry.

Communication↗