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Results for “Truth Disclosure”

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PubMed2001

Prognostic disclosure to patients with cancer near the end of life.

BACKGROUND: Patients' understanding of their prognosis informs numerous medical and nonmedical decisions, but patients with cancer and their physicians often have disparate prognostic expectations. OBJECTIVE: To determine whether physician behavior might contribute to the disparity between patients' and physicians' prognostic expectations. DESIGN: Prospective cohort study. SETTING: Five hospices in Chicago, Illinois. PATIENTS: 326 patients with cancer. INTERVENTION: Physicians formulated survival estimates and also indicated the survival estimates that they would communicate to their patients if the patients insisted. MEASUREMENTS: Comparison of the formulated and communicated prognoses. RESULTS: For 300 of 311 evaluable patients (96.5%), physicians were able to formulate prognoses. Physicians reported that they would not communicate any survival estimate 22.7% (95% CI, 17.9% to 27.4%) of the time, would communicate the same survival estimate they formulated 37% (CI, 31.5% to 42.5%) of the time, and would communicate a survival estimate different from the one they formulated 40.3% (CI, 34.8% to 45.9%) of the time. Of the discrepant survival estimates, most (70.2%) were optimistically discrepant. Multivariate analysis revealed that older patients were more likely to receive frank survival estimates, that the most experienced physicians and the physicians who were least confident about their prognoses were more likely to favor no disclosure over frank disclosure, and that female physicians were less likely to favor frank disclosure over pessimistically discrepant disclosure. CONCLUSIONS: Physicians reported that even if patients with cancer requested survival estimates, they would provide a frank estimate only 37% of the time and would provide no estimate, a conscious overestimate, or a conscious underestimate most of the time (63%). This pattern may contribute to the observed disparities between physicians' and patients' estimates of survival.

Humans↗
PubMed1992

A proposal to require attorney disclosure when a client communicates intent to harm.

The attorney-client privilege has been and will remain sacred. But a human life is more sacred. When a life is threatened, and the attorney has knowledge of this danger, he also has an obligation to protect the potential victim. If reasonable care under the circumstances requires him to disclose certain confidences, then an exception to the rule of privilege must be made. DR 4-101 (c)(3) should be changed to reflect this obligation.

Confidentiality↗
PubMed2003

Self-perceived responsibility of HIV-seropositive men who have sex with men for preventing HIV transmission.

Relatively little attention has been paid to unique factors that may motivate HIV-seropositive men who have sex with men (MSM) to prevent HIV transmission. This study examines the beliefs of 250 HIV-seropositive MSM about their responsibility for protecting sex partners from HIV infection. Participants completed an open-ended interview about their sexual practices, substance use, and other HIV-related issues. Seventy percent of participants were men of color. Most participants (72%) spontaneously mentioned issues related to responsibility that were represented by three themes: (1) personal responsibility for protecting sex partners, (2) partners' responsibility for protecting themselves, and (3) mutual responsibility. These beliefs were expressed by 63%, 24%, and 12% of respondents, respectively. Motivations underlying beliefs about personal responsibility included altruism, self-standards, and self-interest. Beliefs about personal responsibility were influenced by participant characteristics, partner characteristics, disclosure of HIV status, and contextual factors. The findings suggest that self-perceived responsibility may be an important factor that affects HIV-seropositive MSM's sexual decision making.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Breaking the news of traumatic brain injury and incapacities.

PRIMARY OBJECTIVE: This paper presents research results regarding disclosure of traumatic brain injury (TBI) diagnosis and resulting deficits of a study aiming to investigate the experiences of individuals who had sustained a TBI, their families, the physicians and health professionals involved, from the critical care episodes and subsequent rehabilitation. RESEARCH DESIGN: Semi-structured interviews were conducted with individuals who had sustained a TBI (n = 8) and their families (n = 8) as well as with the health professionals (or service providers) (n = 22) and physicians (n = 9) who provided them care. MAIN OUTCOMES AND RESULTS: Results revealed that the quality of the disclosure is strongly influenced by the medical uncertainty surrounding the TBI and the difficulties of healthcare professionals in dealing with the family's emotions. CONCLUSIONS: Delivering bad news is always difficult, but it is possible to make this harrowing experience easier and, in so doing, enhance patient and family resilience.

Adolescent↗
PubMed2006

Do general practitioners disclose correct information to their patients suspected of dementia and their caregivers? A prospective observational study.

This study describes what general practitioners (GPs) tell persons who appear to have dementia and their caregivers after assessment and to estimate the number of (in)correct disclosures and their determinants. In a prospective observational study 64 GPs were instructed to use the Dutch national dementia guideline on all consecutive elderly (55+) patients, newly suspected of dementia. Patients were referred to a multi-disciplinary memory clinic team that served as a diagnostic reference standard. Both GPs and the memory clinic team registered their findings and actions on a predefined form. A total of 107 possible cases of dementia were recorded, and 83 were accompanied by their caregiver. After assessment, dementia was considered present in 69 persons, absent in 29, and uncertain in nine. The GPs told the diagnosis to 42% of people with probable dementia and to 74% of their caregivers. The caregivers' experiences were noted in most cases but specific advice was provided in less than half. Only increased severity of dementia was related to more disclosure to patients and caregivers. Disclosures by GPs were correct in most cases. The GPs were much more reluctant to tell the probable dementia diagnosis to patients than to (family) caregivers. The GPs disclosed incorrect diagnoses to two people without dementia, and two with dementia according to the memory clinic diagnosis.

Adult↗
PubMed2004

An emerging framework for human becoming criticism.

This column presents a new framework for researchers to consider as a guide when participating in the process of scholarly critique. The framework is aligned with the philosophical view of Gadamerian hermeneutics. The emerging framework, consistent with the human becoming school of thought, builds on ideas from literary theory, specifically reception or reader-response theory, and the human becoming hermeneutic method. Three processes- sketching the horizon of expectation, illuminating artistic disclosure, and enhancing the original with artform-guide reviewers to bring forth the contributions of the researcher and to enhance the researcher's contribution with artform. The emerging framework will enable researchers to participate in interpretive discourse and to advance the understanding of a scholarly community.

Evaluation Studies as Topic↗
PubMed2000

"Telling tales out of court": a pilot study of experts' disclosures about opposing experts.

A pilot questionnaire surveyed forensic psychiatrists and psychologists about information they would feel it appropriate to disclose to their retaining attorneys about an opposing expert witness. A spectrum of hypothetical disclosures was offered, varying in their relevance to the case at hand and in their degree of "public" versus "personal" information. Respondents agreed significantly that "public" information could be disclosed to one's attorney, but responses about disclosing "personal" information varied widely. The findings and their implications are briefly discussed.

Data Collection↗
PubMed2003

Blood-donor perceptions of health history screening with a computer-assisted self-administered interview.

BACKGROUND: Computer-assisted self-interviewing (CASI) has been shown to promote disclosures of sensitive information. Using CASI to screen blood-donor candidates might encourage reports of deferrable risks without discouraging eligible donors. STUDY DESIGN AND METHODS: In 1998, an anonymous mail survey was sent to donors from eight blood centers. The relationship of donor demographics, donation history, and infectious risks (HIV test-seeking behavior, unreported deferrable risk, or reactive donor-screening test result) on attitudes toward CASI were assessed. RESULTS: Of 92,581 blood donors surveyed, 52,650 (57%) responded; of these, 4713 (7%) had an infectious risk. Among donors with risks, 29 percent felt they would be encouraged to reveal personal data, and 7 percent reported they would be discouraged from donating by CASI. Young, minority, female, and first-time donors were the most likely to report that CASI would encourage personal disclosures. Among donors without risks, 5 percent felt CASI would discourage them from donating. CONCLUSIONS: Although most donors felt their donation practices would not be influenced, CASI might reduce the proportion of donors with infectious risks by fostering personal disclosures and self-deferrals. The potential for CASI to improve donor screening and increase appropriate self-deferrals should be balanced against the possible loss of reluctant safe donors.

Adolescent↗
PubMed2006

Patient confidentiality vs disclosure of inheritable risk: a survey-based study.

BACKGROUND: As the field of genetic medicine advances and more tests for genetic diseases become available, a dilemma of legal and ethical importance will be increasingly encountered by family physicians. Protecting the confidentiality of a patient with a genetic disease when the patient's family is at risk for inheriting the disease is a conflict that more and more physicians will be forced to address. METHODS: In March 2003, osteopathic family physicians in New Jersey were given a vignette in which a patient reveals that he has a genetic disease and demands that the information be kept confidential. The physicians were then given a 33-item questionnaire asking their opinions about disclosing an untreatable and a treatable disease to each of the patient's children and their mother, a former spouse. Also, physicians' opinions on larger issues were gathered, such as potential legal consequences of their actions and state laws in this area. Correlations between physicians' opinions and their demographic characteristics were also explored. Data were analyzed using Pearson product moment correlations and repeated-measures analyses of variance. RESULTS: Physicians tended to agree that adult children should be told if the disease were treatable, and these physicians were willing to accept responsibility for deciding whom to tell. With regard to the characters in the vignette, physicians felt comfortable telling the 22-year-old daughter, were unsure about telling the 17-year-old son, and would not tell either a former spouse or the 12-year-old son. The respondents agreed that state laws should permit disclosure rather than require it, and they did not think state laws should forbid it. CONCLUSION: The authors recommend that states draft a definitive public policy about when, how, and whether to disclose pertinent medical information to those at risk for inheriting a genetic disease.

Adult↗
PubMed1998

[Current trends and problems in disclosure to lung cancer patients].

To assess current trends in the disclosure of cancer, we studied patients with primary lung cancer. Ninety-nine of 101 surgical patients (98.0%) and 96 of 128 non-surgical patients (75.0%) had been informed of their illness. Family members of 2 surgical patients refused to allow disclosure due to concerns about mental intolerance. Reasons for non-disclosure to non-surgical patients ranged from rejection by family members (29 patients) to a lack of ability to understand (3 patients). No mental problems were observed after disclosure. All but 11 patients were informed of their cancers by their physicians. Decisions regarding disclosure were not related to the pathological type or clinical stage of the cancer. For example, small cell carcinoma did not influence methods of or decisions concerning disclosure. Among non-surgical patients, the frequency of disclosure decreased with aging. However, no clear-cut factor appeared to influence the disclosure of metastatic sites. Views about informed consent are still at a transitional stage in Japan. The doctrine that patients have the right to be informed of their cancers and to choose their treatment has not always been the best policy in practice. Nevertheless, it seems desirable that approaches to disclosure adequately reflect the special needs of each patient and provide as much information as possible to allow each patient to make an accurately informed decision about treatment options. Such approaches would foster better relationships between physicians and their patients and relieve physicians from pressure to tell a medical lie.

Adult↗
PubMed1991

[How reliable is parental disclosure?].

Research on the reliability and validity of retrospective and actual reports of parents is reviewed. Parents seem to be able to report birth weight, age at first walking alone and academic achievement reliably. Correlations between developmental or intelligence test results and parental estimates are moderate to high. Reports of psychopathological symptoms differ considerably between groups of informants. Item content and method can influence the reliability and validity. A general tendency to overestimate their own child could not be demonstrated.

Child↗
PubMed1998

Ethical relativism in a multicultural society.

The multicultural composition of the United States can pose problems for physicians and patients who come from diverse backgrounds. Although respect for cultural diversity mandates tolerance of the beliefs and practices of others, in some situations excessive tolerance can produce harm to patients. Careful analysis is needed to determine which values are culturally relative and which rest on an underlying universal ethical principle. A conception of justice as equality challenges the notion that it is always necessary to respect all of the beliefs and practices of every cultural group.

Adolescent↗
PubMed2006

Using medical-error reporting to drive patient safety efforts.

IMPROVING PATIENT SAFETY has become one of the driving forces in health care delivery. Honest, accurate disclosure of medical errors and close calls is crucial to gain a better grasp of problems, make effective changes, and evaluate progress. ALTHOUGH FEAR OF MALPRACTICE litigation remains a major deterrent to medical-error reporting, disclosure allows organizations to benefit from one another's experiences. Accountability necessitates mandatory reporting to external organizations, but a wide variety of reporting systems exist, each with its own advantages and shortcomings. National standardized reporting is a major objective for the patient safety movement. STAFF MEMBER INVESTMENT is a key factor in the safety process and needs to extend beyond the reporting procedure.

Humans↗
PubMed2003

Secrets and lies: the dilemma of disclosing the diagnosis to an adult with dementia.

Guidelines state that doctors should reveal the diagnosis to the carer and the person with dementia. Carers may, however, not wish the diagnosis to be disclosed. We investigated carer and patient characteristics associated with the wish for disclosure. Fifty-four per cent of 100 carers wished the diagnosis to be revealed. The only significant predictor of wish for diagnosis to be hidden was a lower Mini Mental State Examination <17. Clinicians should strive for earlier diagnosis and to address carer concerns, disclose the diagnosis and thus avoid the need for secrets and lies.

Adult↗
PubMed1992

Cancer diagnosis disclosure in a Spanish hospital.

At the Clinic Hospital in Barcelona, Spain, 167 cancer patients and 380 hospital health care workers were interviewed about cancer diagnosis disclosure. Only 25 patients (15%) were correctly informed of their diagnoses. Breast cancer patients were significantly more often informed than patients with other malignancies (p less than 0.05). Two hundred seventy-two of 380 hospital health workers interviewed (71%, p = 0.00) would want to know their own diagnoses should they suffer from cancer in the future, but only 19% (p = 0.00) would want such a diagnosis revealed to their similarly afflicted relatives. This information model, based on cancer taboo, is largely preferred by these healthy people and is followed by doctors, patients and family members. To inform our patients better, the mandatory uniform disclosure of the true diagnosis is not likely to be constructive at present. In our opinion a pragmatic approach is more realistic and humane. Nevertheless, we must hope that more modern cancer education will lead to the gradual elimination of this taboo in our society.

Aged↗
PubMed2004

Use of outcomes information in acute inpatient rehabilitation.

OBJECTIVE: To describe the ways in which rehabilitation outcomes information is used in the acute inpatient rehabilitation industry and the industry's views on the topic of public disclosure of rehabilitation outcomes information. DESIGN: A mixed-methods approach, featuring data from 39 informational telephone interviews with rehabilitation industry stakeholders followed by a survey of 95 randomly sampled acute inpatient rehabilitation provider organizations. RESULTS: Both the informational interviews and survey findings revealed that there is currently little stakeholder demand for functional outcomes information. Outcomes information is primarily used within provider organizations to track the effectiveness of rehabilitation services. There is general consensus among rehabilitation provider organizations in favor of public disclosure of outcomes information. CONCLUSIONS: Outcomes information is not routinely shared with rehabilitation stakeholders (i.e., payers and consumers). Rehabilitation providers and industry stakeholders generally express favorable attitudes toward public disclosure of outcomes information. Stakeholders' perceptions of current barriers and facilitators of outcomes information provide insight into the steps that can be taken toward greater transparency in the rehabilitation industry.

Activities of Daily Living↗
PubMed2006

Disclosure of medical errors: what factors influence how patients respond?

BACKGROUND: Disclosure of medical errors is encouraged, but research on how patients respond to specific practices is limited. OBJECTIVE: This study sought to determine whether full disclosure, an existing positive physician-patient relationship, an offer to waive associated costs, and the severity of the clinical outcome influenced patients' responses to medical errors. PARTICIPANTS: Four hundred and seven health plan members participated in a randomized experiment in which they viewed video depictions of medical error and disclosure. DESIGN: Subjects were randomly assigned to experimental condition. Conditions varied in type of medication error, level of disclosure, reference to a prior positive physician-patient relationship, an offer to waive costs, and clinical outcome. MEASURES: Self-reported likelihood of changing physicians and of seeking legal advice; satisfaction, trust, and emotional response. RESULTS: Nondisclosure increased the likelihood of changing physicians, and reduced satisfaction and trust in both error conditions. Nondisclosure increased the likelihood of seeking legal advice and was associated with a more negative emotional response in the missed allergy error condition, but did not have a statistically significant impact on seeking legal advice or emotional response in the monitoring error condition. Neither the existence of a positive relationship nor an offer to waive costs had a statistically significant impact. CONCLUSIONS: This study provides evidence that full disclosure is likely to have a positive effect or no effect on how patients respond to medical errors. The clinical outcome also influences patients' responses. The impact of an existing positive physician-patient relationship, or of waiving costs associated with the error remains uncertain.

Attitude to Health↗
PubMed1991

Sexual abuse of children.

Sexual abuse of children is a pervasive and growing problem, which has demanded the attention of several professional groups. Because most children never reveal the abuse, understanding the psychodynamics involved is fundamental to the detection of these victims. Physicians should be aware of the masked clinical and behavioral indicators of sexually abused children that signal the need for further questioning. Through appropriate inspection of genitalia and anus in routine examination of the child, the physician can establish rapport and a foundation of trust critical for disclosure of abuse. The history the child gives is the most important evidence and is most credible when spontaneous, consistent, and detailed. Physicians must report any suspicion of child abuse to the Texas Department of Human Services (TDHS) and/or law enforcement agencies. Finally, physicians can help prevent such sexual abuse by providing anticipatory guidance for parents and caretakers of children.

Child↗