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PubMedDate not supplied

Pediatric HIV medication adherence: the views of medical providers from two primary care programs.

INTRODUCTION: The purpose of this study was to examine medical providers' views from two primary care programs regarding adherence to antiretroviral therapy among HIV-infected children. METHOD: Ten medical providers (five physicians and five registered nurses) working with perinatally HIV-infected children completed a structured questionnaire examining provider-patient/family relationship and participated in an individual qualitative interview regarding providers' views on pediatric adherence to antiretroviral therapy. RESULTS: Providers believed that the limited treatment options currently available to HIV-infected children presented families with tremendous challenges to adherence. Most children were prescribed difficult treatment regimens and needed increasingly complex regimens for possible success in the future, placing further demands on the adherence issue. Although providers were able to identify several helpful communication strategies in theory, they were not able to consistently implement them in practice. Further, many families are also struggling with poverty, mental health and substance use problems, additional HIV disease in the family, and disclosure issues. DISCUSSION: Adherence to antiretroviral therapy is a long-term, ongoing problem that is directly tied to the family life of the HIV-infected child. Providers clearly play an integral part in this struggle.

Antiviral Agents↗
PubMedDate not supplied

Disclosure of HIV status to medical providers: differences by gender, "race," and immune function.

OBJECTIVE: The authors used data from a larger study to explore differences by gender, self-reported racial identification, and immune function in disclosure of HIV-positive serostatus to medical providers (dentists, family doctors, and emergency room [ER] and obstetrics-gynecology [ob/gyn] providers). METHOD: The authors analyzed interview responses from a convenience sample of African American and white men and women receiving HIV medical care at urban hospitals and clinics in St. Louis. Missouri. RESULTS: Of 179 respondents using at least one of three types of providers, 124 (69%) disclosed their HIV status to all applicable types of providers, 39 (22%) disclosed to only one or two types of providers, and 16 (9%) did not disclose to any of these types of providers. "Race" and CD4 count, but not gender, were independently associated with disclosure to dentists, family doctors, and ER providers in multivariate logistic regression analyses. CONCLUSIONS: Differences in disclosure rates, especially among patients who may be asymptomatic, suggest a need for public health education of both medical providers and patients with HIV.

Adolescent↗
PubMed2003

Reasons for HIV disclosure or nondisclosure to casual sexual partners.

The purpose of this study was to investigate reasons HIV-positive gay men give for disclosing or not disclosing their serostatus to their casual sexual partners. Participants were 78 HIV-positive gay men who were part of a larger HIV and disclosure project. A clear factor structure for disclosure emerged which suggests that issues of responsibility dominated men's decisions to disclose. No clear factor structure for nondisclosure emerged. Reasons for disclosure or nondisclosure to casual sexual partners were varied and this data could provide new insights for secondary prevention efforts. More research needs to be conducted to better understand salient issues in considering whether to disclose.

Adolescent↗
PubMed2005

Disclosure of natural product use to primary care physicians: a cross-sectional survey of naturopathic clinic attendees.

OBJECTIVE: To determine factors that predict disclosure of natural product use by patients to their primary care physicians. METHODS: An 18-item survey about health care use and communication was distributed to patients who presented to the Canadian College of Naturopathic Medicine in March 2003. We examined correlations between responses and created a multivariable logistic regression model to explore which factors were associated with patients' discussion of natural product use with their primary care physicians. RESULTS: The survey was given to 198 patients, 174 of whom responded (response rate, 87.9%). Most respondents (161 [92.5%] of 174) made use of natural products, and many (61 [41.5%] of 147) reported that they did not discuss natural product use with their primary care physician. The most significant factor predictive of patients having discussed natural product use with their primary care physician was having their primary care physician ask about natural product use (odds ratio, 18.77; 95% confidence interval, 5.06-69.62). Most respondents (107 [69.9%] of 153) indicated that their primary care physician did not ask about natural product use. CONCLUSIONS: An important number of patients who visit a naturopathic clinic do not disclose natural product use to their primary care physicians. Our findings suggest that disclosure rates could be improved by physicians taking a more active role in asking their patients about natural product use.

Adolescent↗
PubMedDate not supplied

Legal aspects of continence: disclosure of a medical condition.

This article explores the issue of patient confidentiality and the exceptions to that duty. Even if a health professional considers that there would be a public interest in a patient's condition being made known, the patient is entitled to have his confidential information kept secret. There are recognized exceptions in law to the duty of confidentiality, and the guidance issued by the health professional registration bodies should be followed.

Confidentiality↗
PubMed1998

Group psychotherapy for persons with HIV and AIDS-related illnesses.

Although some individuals are able to cope well with the challenges posed by HIV and AIDS, others experience psychological difficulties. This article reviews factors that facilitate or hinder successful coping with HIV including preexisting psychological functioning, medical health status, quality and adequacy of social support, stress-and-coping style, and perceived expected benefits of treatment. The article reviews studies evaluating the effects of group psychotherapy intervention for persons living with HIV. The article then describes clinical issues encountered in therapy groups for persons with HIV. These clinical issues include the presence of coexisting problems unrelated to HIV/AIDS, disclosure of HIV-positive serostatus to others, making changes in transmission-risk-behavior practices, AIDS-related bereavement and caregiving stress, establishing social supports, adhering to medical care regimens, and developing a positive self-identity as a person living with HIV. Practical considerations of group therapy for HIV-positive clients are also described.

Adaptation, Psychological↗
PubMedDate not supplied

Disclosing the diagnosis of pediatric HIV infection: mothers' views.

ISSUES AND PURPOSE: The stigma of HIV infection creates barriers to disclosure. The purpose of this study was to identify to whom biological and foster mothers disclose the diagnosis of HIV infection, discuss their rationale, and describe the recipient's reactions. DESIGN AND METHODS: A descriptive, qualitative study included biological (n = 9) and foster (n = 11) mothers of children with HIV infection. RESULTS: Three themes emerged from the data: Telling for support, determining who should know, and telling children. These themes were present for both biological and foster mothers. PRACTICE IMPLICATIONS: It is important for nurses to realize that parental disclosure of the diagnosis of HIV infection is a long-term, age-appropriate process that will take place over many discussions and time, and should have the support of the interdisciplinary team. Additional psychological support also should be available.

Adult↗
PubMed2001

Publicly disclosed information about the quality of health care: response of the US public.

Public disclosure of information about the quality of health plans, hospitals, and doctors continues to be controversial. The US experience of the past decade suggests that sophisticated quality measures and reporting systems that disclose information on quality have improved the process and outcomes of care in limited ways in some settings, but these efforts have not led to the "consumer choice" market envisaged. Important reasons for this failure include limited salience of objective measures to consumers, the complexity of the task of interpretation, and insufficient use of quality results by organised purchasers and insurers to inform contracting and pricing decisions. Nevertheless, public disclosure may motivate quality managers and providers to undertake changes that improve the delivery of care. Efforts to measure and report information about quality should remain public, but may be most effective if they are targeted to the needs of institutional and individual providers of care.

Attitude to Health↗
PubMed1989

Cancer patients: their desire for information and participation in treatment decisions.

The relationship between cancer patients' desire for information and their preference for participation in decision making has been examined. Approximately 77% of the 52 patients reported that they had participated in decision making to the extent that they wished, while most of the remaining 23% would have preferred an opportunity to have greater input. Although many of the patients actively sought information, a majority preferred the physician to assume the role of the primary decision maker. Ethically, the disclosure of information has been assumed to be necessary for autonomous decision making. Nevertheless, the results of this study indicate that patients may actively seek information to satisfy an as yet unidentified aspect of psychological autonomy that does not necessarily include participation in decision making.

Canada↗
PubMed2006

Accuracy and utility of post-conviction polygraph testing of sex offenders.

BACKGROUND: Polygraphy is used increasingly in the treatment and supervision of sex offenders, but little research has addressed its accuracy in this setting, or linked accuracy with utility. AIMS: To investigate the utility and accuracy of polygraphy in post-conviction testing of community-based sex offenders. METHOD: A self-report measure examined the experiences of offenders with polygraphy. RESULTS: Based on self-report, the polygraph's accuracy was approximately 85%. False negatives and false positives were not associated with demographic characteristics, personality variables or IQ. The majority of offenders found the polygraph to be helpful in both treatment and supervision. Nine percent of offenders claimed to have made false disclosures; these individuals had higher scores on ratings of neuroticism and lower scores on ratings of conscientiousness. CONCLUSIONS: These results support the view that the polygraph is both accurate and useful in the treatment and supervision of sex offenders.

Adolescent↗
PubMed1984

Freedom of information: can we afford to be anything but clinical?

Following the introduction of the Freedom of Information Code and Act in Victoria there have been numerous requests seeking the opportunity for patients and ex-patients to view their own records. This paper explores the clinical context within which patients traditionally have had, or not had, access to their own records, and the ways in which this is now altered by freedom of information legislation. The view is put forward that such disclosure in the past has always been within a clinical context whereas now there is potential for legislative intrusion into the psychiatrist/patient relationship of which the patient record is a part. A number of case examples is provided to exemplify the issues involved and the approach that the Victorian Health Commission has taken to resolve some of the difficulties.

Australia↗
PubMed2004

Error identification, disclosure, and reporting: practice patterns of three emergency medicine provider types.

OBJECTIVES: To gather preliminary data on how the three major types of emergency medicine (EM) providers, physicians, nurses (RNs), and out-of-hospital personnel (EMTs), differ in error identification, disclosure, and reporting. METHODS: A convenience sample of emergency department (ED) providers completed a brief survey designed to evaluate error frequency, disclosure, and reporting practices as well as error-based discussion and educational activities. RESULTS: One hundred sixteen subjects participated: 41 EMTs (35%), 33 RNs (28%), and 42 physicians (36%). Forty-five percent of EMTs, 56% of RNs, and 21% of physicians identified no clinical errors during the preceding year. When errors were identified, physicians learned of them via dialogue with RNs (58%), patients (13%), pharmacy (35%), and attending physicians (35%). For known errors, all providers were equally unlikely to inform the team caring for the patient. Disclosure to patients was limited and varied by provider type (19% EMTs, 23% RNs, and 74% physicians). Disclosure education was rare, with <or=15% of any provider type receiving such instruction. Yet, 59% of physicians had observed another provider disclose an error to a patient. Error discussions are widespread, with all providers indicating they discussed their own as well as the errors of others. CONCLUSIONS: This study suggests that error identification, disclosure, and reporting challenge all members of the ED care delivery team. Provider-specific education and enhanced teamwork training will be required to further the transformation of the ED into a high-reliability organization.

Attitude of Health Personnel↗
PubMed1999

Nursing students' response to a case study in ethics.

This paper describes the responses of undergraduate nursing students to an ethical clinical case study. Students in a baccalaureate program were given a case study before a lecture on ethical principles and the same case study after this lecture. These responses raise questions about the content of nursing ethics classes in Japan. The place of individual patient rights and the role of the family in a situation of non-disclosure about diagnosis and prognosis were major issues for the students. The responses reveal the problem of the 'nurse-in-the-middle' between the patient and others whose values differ. Students' post-lecture responses emphasized communication among the people involved.

Adult↗
PubMed2005

Understanding the experience of HIV/AIDS for women: implications for occupational therapists.

BACKGROUND: Within the past few years, HIV/AIDS has shifted from being an acute, palliative disease to one that is more chronic and episodic in nature. This shift has major implications for the role of occupational therapy in women's lives. Very few studies, however, have examined the perspective of women living with HIV/AIDS from an occupational therapy perspective. PURPOSE: This qualitative study was designed to examine the experiences of five women living with HIV/AIDS in Southern Ontario and to begin to explore the implications of these findings for occupational therapy. METHOD: Through the implementation of five in-depth interviews, a phenomenological approach was used to explore the lived experience of women with HIV/AIDS. RESULTS: Four main themes emerged: fearing disclosure, experiencing challenges (physical and psychological), having supportive networks, and coping positively with being HIV positive (spirituality and opportunity for living and learning). PRACTICE IMPLICATIONS: There are several potential roles for occupational therapy in working with women who are living with HIV/AIDS More studies need to be pursued in this area of rehabilitation.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Communicating life-threatening diagnoses to patients in the emergency department.

Disclosing a new, life-threatening diagnosis to a patient is difficult for the physician, the patient, and the family. The disclosure provokes a wide range of reactions from both the patient and family, to which the emergency physician must respond. This interaction is further complicated by the limited time the emergency physician can spend with the patient, the strained resources of a busy emergency department (ED), and, oftentimes, the inability to make a definitive diagnosis based on the ED workup and evaluation. We present a case seen recently in the ED in which a new, life-threatening illness requires disclosure. We offer guidelines for the emergency physician that emphasize patient- and family-centered disclosure of the worrisome diagnostic findings. Additionally, we discuss the essential roles of other allied health professionals in addressing the patient's nonmedical concerns (eg, health insurance, social issues) and in creating a smooth transition for the patient from the ED to further inpatient or outpatient care.

Adult↗
PubMed2006

Expressive disclosure and benefit finding among breast cancer patients: mechanisms for positive health effects.

A randomized trial (n = 60; A. L. Stanton, S. Danoff-Burg, L. A. Sworowski, et al., 2002) revealed that 4 sessions of written expressive disclosure or benefit finding produced lower physical symptom reports and medical appointments for cancer-related morbidities at 3-month follow-up among breast cancer patients relative to a fact-control condition. The goal of this article is to investigate mechanisms underlying these effects. Within-session heart rate habituation mediated effects of expressive disclosure on physical symptoms, and greater use of negative emotion words in essays predicted a decline in physical symptoms. Postwriting mood and use of positive emotion and cognitive mechanism words in essays were not significant mediators, although greater cognitive mechanism word use was related to greater heart rate habituation and negative emotion word use.

Affect↗
PubMedDate not supplied

[The cancer diagnosis disclosure for the patient and healthcare professionals].

The disclosure of the cancer diagnosis is considered a crucial moment and the way healthcare professionals communicate it interferes directly in patient's relationship with his/her diagnosis. The study aims to discuss about the importance of the disclosure of the cancer diagnosis for the patient and for the health professionals. The methodology is an essay. The discussion begins with works perspectives which involves health professionals' interaction with the patient and cancer diagnosis disclosure presenting the difficulties lived by both as well as nursing performance in this process. The difficult task of revealing the diagnosis can diverge in each one's experience field and health professionals should be prepared to act in an effective way by taking into account patient's cultural, social and psychological background related to the way the information is communicated to them.

Humans↗