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Results for “Truth Disclosure”

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PubMed2005

Disclosure preferences regarding cancer diagnosis and prognosis: to tell or not to tell?

Telling people that they have cancer has a great impact on their lives, so many doctors are concerned about how they should inform patients about a cancer diagnosis and its prognosis. We conducted a general population survey in Japan to investigate people's preferences on receiving this information. There were no significant differences in respondents' preferences according to the seriousness of the cancer. Full disclosure of the diagnosis was preferred by 86.1% of the respondents, while 2.7% wanted non-disclosure. As for the initial provision of information, the majority preferred partial disclosure concerning the prospects of complete recovery (64.5%) and the expected length of survival (64.1%). Those who responded negatively to the statement, "If I am close to the end of my life, I want to be informed of the fact so I can choose my own way of life", were more likely to want non-disclosure on diagnosis. The results suggest that, at the first opportunity of providing information, a disclosure policy of giving patients full details of their diagnosis and some information on prognosis can satisfy the preferences of most patients. Contrary to popular belief, the seriousness of the cancer and people's demographic characteristics displayed little impact in this study.

Adult↗
PubMedDate not supplied

Disclosing information and treating patients as customers. A review of selected issues.

Although many insist that full disclosure of health care information is essential, it may be insufficient to help patients make health care decisions. As the patient's agent, the physician should translate medical information for the patient. Providing information on the quality of care may also be a problem. In view of the lack of consensus among experts about measures of quality, widespread disclosure of quality data should occur only when the data are better validated. In the HMO setting, patients may also face complex choices about insurance coverage that are beyond their comprehension. The HMO is challenged to determine the degree to which individuals must be treated as patients rather than as consumers.

Advertising↗
PubMed2003

The cultural differences in perceived value of disclosure and cognition: Spain and Canada.

A previous multicentre international study on sedation at the end of life has detected major differences between Canadian and Spanish patients. This was particularly evident in the need to sedate Spanish patients for psychological/existential distress. This study was designed to explore the hypothesis that marked differences in the value patients and families attach to disclosure and cognition were a factor. The study population included patients referred to two palliative care consulting services based in acute care hospitals in Madrid, Spain (M), and in Edmonton, Canada (E). Questions addressed the issue of clear thinking, pain/nausea-medication-induced somnolence/confusion, anxiety/antidepressant-medication-induced somnolence/confusion, details of diagnosis. One hundred patients were evaluated on each site. Patients and families in E placed a higher value on clear thinking, change in medication causing somnolence/confusion, and wanting full disclosure. Patients and families in E agreed almost 100% of the time, while agreement in M varied from 42% to 67%. These results suggest major differences in the perceived value of clear cognition and disclosure of information between patients and families in E and M. The lack of agreement between patients and families in M is a further significant factor that may complicate communication with patients and families, as well as medical management.

Aged↗
PubMed1995

Concurrent validity of the MCMI-II modifier indices.

The relationships between the three Modifier Indices (Disclosure X, Desirability Y, and Debasement Z) of the Millon Clinical Multiaxial Inventory-II (MCMI-II) and the validity and clinical scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were explored. A sample of 125 psychiatric inpatients was administered both personality measures within 7 days of admission. The pattern of Pearson correlation coefficients and principal component factors was seen as generally supporting the validity of the three MCMI-II Modifier Indices. However, the Disclosure and Debasement Indices were highly intercorrelated and similar in their MMPI-2 associations. The Desirability Index functioned in a more unique manner and demonstrated both convergent and divergent relationships with MMPI-2 Validity and Clinical scales.

Adult↗
PubMed2002

Priorities for disclosure of the elements of informed consent for research: a comparison between parents and investigators.

BACKGROUND: Disclosure is a key element of the informed consent process. This study examines and compares the priorities for disclosure of the elements of informed consent between parents of paediatric research subjects and investigators. METHODS: The study sample comprised 184 parents who had been approached for permission to allow their child to participate in a clinical anaesthesia or surgery study. Parents were asked to rank 11 elements of informed consent that they believed were most important for them to know before allowing their child to participate in a research study. In addition, 38 investigators were asked to rank, in order of importance, the same elements that they felt were most important for parents to know. RESULTS: The results showed that risk was the most important element considered by both parents and investigators. However, parents placed significantly greater importance on knowledge of the potential benefits to their child (direct) and to other children (indirect) compared with investigators, and less importance on the details of the protocol and the element of voluntariness. CONCLUSIONS: These results demonstrated differences in the priorities for disclosure of the elements of consent between parents and investigators. As such, they may be important in directing the investigator to focus on the elements that are most important to parents and thus maximize their ability to provide truly informed consent.

Adult↗
PubMed2004

Medical errors and the trainee: ethical concerns.

How medical errors are handled by individual physicians and hospital systems is a topic of considerable interest. In teaching hospitals, medical students and house officers often observe and commit mistakes. Commission of a mistake is associated with serious emotional turmoil and uncertainty among trainees as well as experienced physicians. Although disclosure is the ethical standard, the consequences of disclosure are feared by many. This article focuses on the issues that surround medical errors as they pertain to medical students and residents. It is important that this group of future physicians has appropriate training, mentoring, and support when dealing with errors.

Aged↗
PubMed2006

Effective strategies to increase reporting of medication errors in hospitals.

A major concern for patient safety in hospitals is accurate medication administration. To improve the medication administration process, nurses and pharmacists must report system problems. Although staff supported the concept of medication error reporting, they did not report errors. Inherent fear of retribution, punitive actions, and professional humiliation prevented self-reporting of medication errors. Our hospital's quality improvement department developed, implemented, and evaluated a program called LifeSavers. Its purpose was to build a nonpunitive culture and to increase medication error reporting by staff. In one year, the LifeSavers program increased medication error disclosures from 14 to 72 reports per month. The successful development of a nonblame culture of medication error reporting led to identified sources of problems and improvement of the medication administration system.

Communication↗
PubMed2000

Mothers with HIV/AIDS and their children: disclosure and guardianship issues.

For many mothers living with HIV/AIDS, whether, when, and how to disclose their HIV diagnosis to their children and arranging for future care are important although agonizing issues. Due to the increasing number of children who lose their mothers to AIDS and the dearth of empirical information about them, these issues are increasingly important to research. This study of 188 HIV-positive mothers and their 267 children of minor age in New York City revealed that only half the mothers had disclosed their HIV diagnosis to at least one of their children and only 57% had made formal plans for the children's care. As expected, older children were more likely to be informed than younger children. Contrary to some previous research, maternal disclosure was not related to ethnicity, advanced illness, improved psychological well-being, or greater or more satisfying social support resources. Implications for future research and provision of services to this group of women are discussed.

Adolescent↗
PubMed2005

Serostatus disclosure to sexual partners by HIV-infected women before and after the advent of HAART.

HIV-positive individuals have been encouraged by public health officials to disclose their HIV status to sexual partners. In deciding what to do, however, they must weigh what they see as the potential costs and benefits of disclosing or not disclosing. In the present report we examine the reasons women offer for disclosing or not disclosing their serostatus and the reactions to that disclosure among two matched samples of HIV-infected women. The first sample was interviewed in 1994-1996, before the widespread availability of HAART; while the second sample was interviewed from 2000-2003 after these medications were widely in use. The findings reveal striking similarities between the two time periods in women's reasons for sharing or not sharing their status with partners, and the reactions to disclosure they experienced. The reconceptualization of AIDS as a chronic illness, rather than an acute fatal one, did not appear to have diminished women's felt responsibility to share their diagnosis with potential sexual partners nor their fear that disclosure would be met with rejection. The data revealed that disclosure remains a highly stressful event for HIV-infected women and that they experience considerable emotional suffering as a result of the diminished sense of self-worth and physical attractiveness brought about by their diagnosis. These findings suggest that intervention efforts toward reducing the stigmatization of HIV/AIDS and for assisting women to manage the stress of disclosure and non-disclosure and address women's feelings of self-worth continue to be needed despite the advent of HAART.

Adult↗
PubMed1983

Telling patients they are mentally ill.

Telling a patient that he is mentally ill is a frequently encountered but rarely simple task. Because a diagnostic disclosure could have a deleterious effect, the decision to inform a patient of his psychiatric illness must be based on whether the patient will utilize the knowledge in a constructive or self-destructive manner. In this article, the author discusses when and how to tell a patient he has a psychological disorder, along with areas of caution and recommended guidelines.

Humans↗
PubMed2005

Informing one's family about genetic testing for hereditary non-polyposis colorectal cancer (HNPCC): a retrospective exploratory study.

BACKGROUND: The family-link approach of case finding is considered the fastest and most efficient approach to trace people with hereditary disease. Therefore, there is a need to understand if, why, and how people with hereditary non-polyposis colorectal cancer (HNPCC) inform their biological family. AIM: To explore people's perspective on informing one's biological family regarding a hereditary predisposition for HNPCC. METHOD: In-depth interviews were conducted with 30 people recruited from the database of the Netherlands Foundation for Detection of Hereditary Tumours (STOET). Interviews were transcribed and analyzed thematically. FINDINGS: Disclosure was stimulated if people felt morally obliged to do so or when they anticipated regret if something happened because it is preventable. Motivation to disclose seemed to increase if there were, especially fatal, cancer cases in the family. Presence of external cues (e.g. professionals) appeared important for disclosure as well. Disrupted and tense family relations were reasons not to disclose, as well as young age of the message recipients and negative experiences at their first attempt to disclose (a novel finding). Disclosure was merely restricted to the nuclear family. A personal approach in this respect was preferred. With respect to content of the disclosure, participants reported to solely announce the presence of the hereditary defect and the possibility of testing. It was mostly considered the recipients' responsibility and own choice to obtain further (technical/medical) information.

Adult↗
PubMed2005

A qualitative investigation of adolescents' experiences with parental HIV/AIDS.

The present qualitative study investigated the implications of parental HIV/AIDS for affected adolescents. The purpose of the study was (a) to understand adolescents' perceptions of and experiences with parental HIV/AIDS and (b) to explore how parental HIV/AIDS affects adolescents' psychosocial functioning, particularly in the home and school environments. Semistructured interviews were conducted with 9 adolescents between the ages of 11 and 17. Major themes included loss, transitions, disclosure, school implications, paradoxical situations, support networks, and coping. Findings validated and expanded on previous research and yielded hypotheses for future research.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The validity of drug use reports from juvenile arrestees.

Using urine test results as a gold standard, this report evaluates the validity of illicit drug use reports for five illicit substances provided in a multisite, national interview study of juvenile arrestees. Willingness to report substance use varied according to the type of substance, the time frame for substance use reports, and the characteristics of the juveniles asked to provide the reports. Youth were particularly reluctant to disclose recent use of cocaine and heroin. Race/ethnicity and willingness to disclose other substance use were the most important predictors of cocaine use disclosure among those testing positive for this drug. Race/ethnicity differences in validity were evaluated in the context of other recent epidemiological findings from surveys of drug use in the United States. Implications for the measurement of drug use in criminal justice samples are discussed.

Adolescent↗
PubMedDate not supplied

Managing the reemergence of anguish: pregnancy after a loss due to anomalies.

OBJECTIVE: To explore and describe parents' experiences and feelings when faced with a pregnancy subsequent to a pregnancy in which they had to choose whether or not to terminate following the diagnosis of a fetal abnormality. DESIGN AND METHOD: Exploratory/descriptive study, using the grounded theory method. SETTING: Participants were recruited through physicians in northeastern Florida and throughout the United States via an Internet support network. PARTICIPANTS: Participants included a registered nurse, a physician, and 22 parents (13 women and 9 partners) who were interviewed during a subsequent pregnancy. RESULTS: Mental anguish resulted after a loss due to fetal anomalies. Such parents felt a loss of innocence and a sense of devastation and experienced changes in spousal relationships, fear of hope, isolation, and stigma. This anguish reemerged during a subsequent pregnancy. The parents managed by developing emotional armor, limiting disclosure of the previous and present pregnancy, delaying attachment to the baby, and forming a strong attachment to health care professionals and other people with similar experiences. CONCLUSIONS: Understanding how parents manage the reemergence of mental anguish during a subsequent pregnancy permits health care professionals to assist these parents. Facilitating parents' efforts to develop emotional armor, limit disclosure, delay attachment to the baby, and attach to health care professionals and support groups can mitigate social and psychologic discomfort for these parents.

Abortion, Therapeutic↗
PubMed2004

Surviving the stresses of clinical oncology by improving communication.

Oncologists grapple with an element of psychological stress that relates to the suffering their patients experience. Although this stress may not be unique to oncology, it is profound. When these stresses become overwhelming, they lead to physician burnout. It is important to understand what makes an oncologist feel successful, what coping strategies help combat burnout, and what adds to the process of renewal. The doctor-patient relationship plays an important role for many oncologists in this regard, and communication skills are increasingly recognized for their importance in this arena. We outline several clinical scenarios that pose particular challenges to oncologists. These include breaking bad news and the patient's response to hearing bad news, transitions in care and offering end-of-life care, participation in investigational studies, error disclosure, complementary and alternative medicine, spirituality, family discussions, and cross-cultural issues. By highlighting the relevant psychosocial issues, we offer insight into, and tools for, an enriched dialogue between patient and oncologist. The doctor-patient relationship can be viewed as the ultimate buffer for dealing with the hassles encountered in clinical oncology.

Communication↗
PubMed2005

Disclosure of medical errors to patients.

The literature review presented here explores the feelings of patients and health care providers regarding the disclosure of medical errors. Findings from these studies illuminate patients' desires for information about medical errors and what they are likely to do with the information once they are informed.

Age Factors↗