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PubMed1999

Japanese nurses' perceptions about disclosure of information at the patients' end of life.

Information disclosure at the end of life is one of the most debated ethical issues in Japan. This paper, using data from a larger questionnaire survey in which 147 Japanese nurses participated, describes nurses' perceptions about this issue. The nurses perceived that non-disclosure of impending death information to patients was the norm in Japan due to its traditional values. This non-disclosure of information has various impacts on clinical nurses. Tension was evident between the Japanese traditional concepts supported by some nurses and the shift toward Western cultural and ethical values supported by other nurses. The nurses confronted uninformed patients who became suspicious, isolated, angry, or died unprepared for their life's ending. The nurses were placed in the middle between the patient and the family, as nurses became keepers of family secrets, or between nurses' ethical obligations to the patient and those of the institution. The nurses had the belief that at the patient's end of life, it is important to change health professionals' attitude from curing to caring.

Adult↗
PubMedDate not supplied

Disclosure of true diagnosis in Japanese cancer patients.

Full disclosure of medical diagnosis to cancer patients in Japan remains controversial. Some physicians in Japan believe that full disclosure may affect the outcome of treatment, create stress and psychiatric problems, or lead to suicide. Although the trend toward full disclosure is increasing in Japan, approximately 70% of current cancer patients are still not fully informed of their condition. In this study, the authors examined the psychiatric status and effects of full disclosure among 100 otolaryngology patients at Tokai University Hospital (50 with benign diseases, 50 with malignancy) using major depression and adjustment disorders criteria of the DSM-III-R Structured Clinical Interview (SCID). This demonstrated that 15 of 50 (30%) patients with benign diseases and 23 of 50 (46%) patients with malignant diseases met the criteria for depression and adjustment disorder; 29 of the 50 patients (58%) with malignant cancer were not informed of their true condition, according to the wishes of their families (21 were fully informed). The prevalence rate of psychiatric disorders was 42.9% among the informed group and 48.3% among the uninformed group. These findings suggest that concealing the true diagnosis was not related to the presence of psychiatric disorders in Japanese cancer patients.

Female↗
PubMed2006

Making sense of syphilis: beliefs, behaviours and disclosure among gay men recently diagnosed with infectious syphilis and the implications for prevention.

BACKGROUND: The resurgence of syphilis in men who have sex with men (MSM) has proved remarkably resilient in the face of innovative control and prevention interventions. Understanding the determinants of the current outbreaks has been restricted by the available data. Qualitative work is needed to understand individual and community experiences of syphilis and to help guide new prevention and control efforts. METHODS: An exploratory study using semi-structured interviews with a convenience sample of MSM (n = 15), recently diagnosed with infectious syphilis, attending sexual health and HIV-outpatient services in Brighton, England. RESULTS: Analysis focussed on men's beliefs about syphilis, their experience of testing and being given a syphilis diagnosis, mediators of 'risky' sexual behaviour and disclosure to social and sexual contacts. Two beliefs--'syphilis is rare' and 'syphilis is dirty'--dominated respondents' accounts. These beliefs coloured every aspect of respondents' clinical and social experience of syphilis, and impeded disclosure and partner notification. They also contributed to misconceptions about behaviours with increased syphilis transmission risk, the mechanics of disease acquisition, health-seeking behaviours and risk-reduction strategies. CONCLUSIONS: The apparent failure of syphilis control measures so far may be due to our limited understanding of MSM's views and experience of STIs other than HIV Syphilis prevention needs to tackle MSM's widely held beliefs about sexual communication, risk behaviour and other STIs. The most useful health education interventions are likely to be those that build on MSM's significant knowledge base and address both the current syphilis crisis and wider sexual health promotion goals.

Adult↗
PubMed2007

Factors correlated with disclosure of HIV infection in the French Antilles and French Guiana: results from the ANRS-EN13-VESPA-DFA Study.

OBJECTIVES: To determine the rate, patterns and predictors of HIV disclosure in the French Antilles and French Guiana. METHODS: A cross-sectional survey was carried out among a 15% random sample (n=398) of the hospital caseload in hospitals providing HIV care. Determinants of disclosure to a steady partner and other members of the individual's social network were analysed using logistic regression. RESULTS: From the time of diagnosis, 84.6% of those in a couple (n=173) disclosed their HIV-positive status to their steady partner, 55.6% disclosed to others, and 30.3% did not tell their status to anyone. Disclosure within a steady partnership was less likely among non-French individuals [Haitians: adjusted odds ratio (AOR) 0.11, 95% confidence interval (CI) 0.02-0.72; other nationalities: AOR 0.13, 95% CI 0.02-0.68]; and among those diagnosed with HIV after 1997 (AOR 0.21, 95% CI 0.05-0.86). Determinants of disclosure to others were found to be sex (women: AOR 2.04, 95% CI 1.24-3.36), age at diagnosis (>or=50 versus<30 years: AOR 0.42, 95% CI 0.19-0.90), nationality (Haitians versus French: AOR 0.39, 95% CI 0.19-0.77), transmission route (non-sexual versus sexual: AOR 3.38, 95% CI 1.12-10.23) and hospital inpatients (hospitalized versus non-hospitalized patients: AOR 1.98, 95% CI 1.17-3.37). After disclosing, social and emotional support from confidants was common and discrimination was infrequent. CONCLUSION: One third of PLWHA had kept their HIV status secret. Interventions targeting the general population and social institutions, and support for PLWHA by healthcare staff are needed to improve the situation.

Adult↗
PubMed1996

Semistructured child sexual abuse interviews: interview and child characteristics related to credibility of disclosure.

This study provided the first empirical description of child and interviewer behaviors occurring within semistructured assessment interviews with children suspected of being victims of sexual abuse. Specifically, relationships between child and interviewer characteristics and interview credibility were examined. Using the Child Abuse Interview Interaction Coding System (CAIICS, Wood, 1990), 55 videotaped interviews of high-risk sex abuse cases seen at a multidisciplinary assessment center were behaviorally coded. Support was found for the interrater reliability and criterion related validity of the CAIICS was found. Results also revealed that children were initially rated as relaxed and displayed few emotional behaviors. Thus, the assumption that a credible disclosure of abuse must necessarily include the display of emotion by the child was not supported. Second, several behavioral differences between preschool and school-aged children were identified: however, no meaningful gender differences were found. Third, supporting evidence was found for both age and gender effects in judgments of interview credibility, with girls and school-aged children judged as more credible. Fourth, while the interviewer did engage in so called leading behaviors, these behaviors were not found to be related to rating of interview credibility. However, interviewer behaviors may have affected interview credibility through an intervening variable. Finally, implications, for further use of the CAIICS for examining interviewer-child interactions, evaluating standards of practice, and assisting with interviewer training are discussed.

Child↗
PubMed2006

Circuit parties: sexual behaviors and HIV disclosure practices among men who have sex with men at the White Party, Palm Springs, California, 2003.

The syphilis epidemic among men who have sex with men (MSM) in major US cities and concomitant increases in high-risk sexual behavior, have raised concerns of increased HIV transmission in this population. Therefore, to provide information for health promotion and disease awareness efforts, we investigated sexual behaviors, partner selection preferences and HIV serostatus disclosure practices of MSM at the White Party in Palm Springs, California. Circuit party attendees reported engaging in unprotected anal sex, however, a high proportion reported disclosing their HIV status. These findings suggest that some gay men are serosorting as a risk reduction strategy or implementing sexual risk reduction strategies to protect themselves and their partners. In our study, HIV-negative men were nine times more likely to report a preference for a seroconcordant sexual partner. The self-protecting attitudes of HIV-negative men in our sample outweighed the partner-protecting attitudes of HIV-positive men. This suggests that prevention interventions focusing on HIV-positive persons are warranted.

Adult↗
PubMed2006

Otolaryngologists' responses to errors and adverse events.

OBJECTIVES: The objectives of this study were to describe otolaryngologists' emotional reactions to errors and adverse events, their efforts to take responsibility, and their attempts to implement improvements. STUDY DESIGN AND METHODS: A retrospective, anonymous survey of 2,500 U.S. otolaryngologists who were members of the American Academy of Otolaryngology-Head and Neck Surgery about errors in their practice was conducted. Respondents were asked whether an error had occurred in their practice in the past 6 months and, if so, to describe the error, its consequences, and any corrective actions taken. Two aspects of these reports stood out, which were beyond the scope of the original study: the respondents' emotional responses and their corrective actions. RESULTS: The response rate was 18.6%. Two hundred ten (45%) respondents reported a total of 212 analyzable error reports and 230 corrective actions. Corrective actions included disclosure to the patient (20 [9%]), ameliorating the consequences of the event to the patient (107 [50%]), personal practice changes (14 [7%]), improvements in the respondent's practice or department (60 [28%]), and hospitalwide or broader corrective actions (19 [9%]). Emotional reactions to errors and adverse events were reported by 22 (10%) otolaryngologists, including regret, embarrassment, guilt, anxiety, loss of temper, and irritation. Legal action was mentioned by five physicians (2%). CONCLUSIONS: Otolaryngologists took actions not only to treat their patients, but also to improve patient care in their practice, department, hospital, or community. Emotional reactions to errors and adverse events are common and need to be addressed in medical training and practice.

Attitude of Health Personnel↗
PubMed1998

Disclosure of results of sonographic examinations to patients by sonologists.

OBJECTIVE: The aim of this study was to assess if patients prefer to talk with a sonologist concerning the results of sonographic examinations. MATERIALS AND METHODS: The study involved outpatients who underwent diagnostic sonography. Technologists offered patients the chance to speak with a sonologist about the results of their sonograms. If requested, a sonologist reviewed the results, and if the study showed an abnormality, its significance was discussed. No treatment recommendations were offered. Patients then filled out a questionnaire. RESULTS: Of the 391 outpatients given the choice, 348 (89%) requested a consultation and 207 of those (60%) returned the completed questionnaire. Of the 207 patients completing the questionnaire, 94% preferred receiving the results from the sonologist rather than from their referring physician. CONCLUSION: We propose a revision of the traditional role of the office-based sonologist to one in which he or she will function as a consultant to both the patient and the patient's physician.

Outpatients↗
PubMed2005

Correlates of women's sexual assault disclosure to informal and formal support sources.

Deciding which people to tell about sexual assault is an important and potentially consequential decision for sexual assault survivors. Women typically receive many different positive and negative reactions when they disclose sexual assault to social support sources. A diverse sample of adult sexual assault survivors in the Chicago area was surveyed about sexual assault experiences, social reactions received when disclosing assault to others, attributions of blame, coping strategies, and PTSD. Analyses were run to identify demographic, assault, and postassault factors differentiating women disclosing to informal support sources only from those disclosing to both informal and formal support sources. Women disclosing to both formal and informal support sources experienced more stereotypical assaults, had more PTSD symptoms, engaged in less behavioral self-blame, and received more negative social reactions than those disclosing to informal support sources only. Implications for future research and intervention are discussed.

Adaptation, Psychological↗
PubMed1998

The impact of counselling on HIV-infected women in Zimbabwe.

The objective of this study was to examine the impact of counselling provided for HIV-infected women in Zimbabwe. Qualitative research was used for data collection. In total, 44 women were heard; most were members of an HIV support group. Doctors and nurses play an important role in the first counselling session, because tests to diagnose HIV-infection are done in the hospital. Interviewed women mention slow disclosure of status as the most comforting way to hear the news. The HIV-infected women experience strong emotions directly after diagnosis. Counselling at this moment is of major importance to reduce fear and can prevent suicide. Women should be prevented from discovering their status on their own. Counselling given once is found not to be effective. First, if only one counselling session is given, the women may not hear or remember all that is said. Second, in case of depression, access to counselling is important and it appears that periods of depression return frequently. Support groups play an important role in providing this continuous counselling. Another advantage of the counselling provided by HIV-positive women of a support group is that the counsellors function as examples.

Adult↗
PubMed2000

Parents' perceptions of disclosure of the diagnosis of cerebral palsy.

The aim of the paper is to propose guidelines for good practice in disclosing the diagnosis of cerebral palsy to parents. The guidelines draw on an interview study with parents of 107 children, average age 24 months, in the South East Thames region. In addition case notes were examined, and mothers completed questionnaires to measure current levels of depression and coping strategies. Dissatisfaction with how the diagnosis had been disclosed was greater where children had been premature and/or low birth weight, where they developed more severe degrees of physical disability, and where the diagnosis had been made later. Dissatisfaction was related to greater degrees of later self reported depression. The guidelines take account of the findings, in particular the need for early close liaison between neonatology and community paediatric services. Suggestions are made for how to ensure implementation and monitoring of good practice.

Adaptation, Psychological↗
PubMed1996

Sexual abuse evaluations in the emergency department: is the history reliable?

The authors assessed agreement on perpetrator identification obtained at two interviews of child victims of sexual abuse. We reviewed charts for 141 children who had undergone both a screening interview by an emergency department physician and an investigative interview by an interdisciplinary team specializing in child sexual abuse evaluation. For 107 (76%) cases, information was consistent; for instance, identification occurred at both interviews or at neither interview. Of the 38 children not identifying the perpetrator at the screening interview, 17 (45%) made disclosure at the investigative interview. Children who made disclosure only at the investigative interview were more likely to have refused to speak to the physician in the emergency department (p = .001). No significant differences were found when data for interview site and perpetrator identification were analyzed by gender of child, time interval between assault and screening interview, time interval between the two interviews, relationship of the alleged perpetrator to the child, performance of the investigative interview on an inpatient versus outpatient basis, and report of genital contact. In conclusion, perpetrator identification obtained during emergency department screening interviews usually agreed with information obtained at the subsequent investigative interview. The investigative interview was most helpful in identification of perpetrators when the child was not the source of the history obtained in the emergency department.

Child↗
PubMed2003

Measuring motivation to change in sexual offenders from institutional intake to community treatment.

Changes in motivational levels occurring during various stages of treatment (institutional and community) were measured among 101 federally sentenced sexual offenders in the Ontario region. Motivation was conceptualized as a dynamic process that can be construed from behavioral referents and more global evaluations of internal features/readiness/psychological stance. Five motivational indices were examined: acceptance of guilt for the offense; acceptance of personal responsibility for the offense; disclosure of personal information; motivation to change behavior; and participation in treatment. Offender scores on these indices were evaluated using the Goal Attainment Scaling protocol (T. Hogue, 1994), at four stages of the treatment process: (1) at institutional assessment, (2) following institutional treatment, (3) upon conditional release to the community, and (4) following a 12-week period of community treatment. Results showed that motivation to change sexually deviant behavior was higher at the end of institutional treatment relative to the initial assessment. However, levels of motivation decreased upon conditional release to the community, with few offenders making significant rebounds following 12 weeks of community treatment. Admission of guilt and acceptance of personal responsibility (measured at community treatment) were both significantly associated with treatment outcome.

Adult↗
PubMed2003

Consent and complications: risk disclosure varies widely between individual surgeons.

AIMS: To assess variations in consent practice for a single operative procedure, namely laparoscopic cholecystectomy, particularly with respect to the frequency with which potential complications are discussed with patients. METHODS: Postal questionnaire sent to general surgeons in the West Midlands and to UK members of the Association of Endoscopic Surgeons of Great Britain and Ireland. Respondents were asked to estimate how often they discussed particular complications with their patients pre-operatively. RESULTS: Conversion to open cholecystectomy was the most frequently discussed complication. Other complications were much less likely to be mentioned overall and there was disturbing variation between individual surgeons in the frequency with which certain complications were discussed, particularly the risk of bile duct injury. CONCLUSIONS: In order for consent to be informed, patients need to be aware of significant risks. Our results indicate a lack of consensus from surgeons as to which risks are significant for this operation and this is likely to be true for other procedures.

Cholecystectomy, Laparoscopic↗
PubMed1985

Effects of intensive clinical exposure on attitudes of medical students toward cancer-related problems.

The attitudes of third-year medical students toward cancer and patients with cancer was examined before and after a 6-week clerkship that included contact with pediatric patients with cancer and their families. A 51-item testing instrument was employed, which included pediatric, adult, and general oncology questions. Beginning with positive attitudes toward the importance of early diagnosis, aggressive therapy, and the complete disclosure of prognosis, the clinical exposure appeared to strengthen the two former attitudes and somewhat diminish the latter. Approval of aggressive cancer therapy was stronger for children than for adults; but approval of both aggressive therapy and intensive surveillance of patients in remission was increased in regard to adults as well as children after the clerkship. A comparison with responses of second-year medical students from another institution suggests that third-year students recognize greater personal limitations in respect to management and adopt a more "defensive" position regarding the patient. In general, during the clerkship, the students moved in the direction of attitudes that were previously designated to be appropriate for students by a multidisciplinary committee that was distinct from the instructional staff in oncology.

Adult↗
PubMed2005

[Coming-out, support from family of origin and relationship adjustment of lesbian mothers whose children were born in a previous heterosexual relationship: an exploratory study].

Lesbian couples differ from heterosexual couples in that they must develop their relationship within an environment that is generally unsympathetic to homosexuality, a fact that could accentuate the importance of family support. Furthermore, the disclosure of their sexual orientation by lesbian couples could also affect the support given by family members. The present study examines the effect of coming-out and family support on the relationship adjustment of lesbian mothers whose children were born within a heterosexual context. It was expected that family support would mediate the relationship between coming-out and relationship adjustment. Fifty-five lesbian mothers currently in a relationship answered questions about their perception of family support, on their coming-out behaviour and their relationship adjustment. Results revealed a positive relationship between coming-out and family support, and between family support and relationship adjustment, however no association was found between coming-out and relationship adjustment. The mediation model was therefore not confirmed. Finally, the authors discuss the implications of these results.

Adaptation, Psychological↗
PubMed2004

What factors influence mental health professionals when deciding whether or not to share a diagnosis of dementia with the person?

This study investigated what influences mental health professionals when deciding whether or not to tell someone with dementia their diagnosis. A qualitative methodology was employed and the data analysed using grounded theory. Currently people with dementia tend not to be told their diagnosis, despite evidence that sharing diagnostic information can improve psychological well-being and adjustment. Why professionals are reluctant to share diagnostic information with people with dementia is unclear, although the literature raises a number of possibilities. Seven professionals were interviewed (two clinical psychologists and five community psychiatric nurses). The main influence on their disclosure practice was uncertainty about whether the person with dementia would want to know the diagnosis, fueled by a fear that to tell them if they did not want to know would cause harm. Professionals also expressed a strong sense of both hopelessness and helplessness when confronted with dementia. This was then projected onto the person with dementia, which in turn led to the professionals adopting an overly protective stance towards them. If professionals are to resolve their sense of uncertainty about what the person with dementia wants, in terms of diagnostic information, services need to develop ways in which the views of people with dementia can be heard and start to influence service provision and policy.

Adaptation, Psychological↗
PubMedDate not supplied

Prevention of triplets and higher order multiples: trends in reproductive medicine.

In the United States and throughout the world, today's healthcare providers are challenged by the risks of multiple gestation pregnancy. Assisted reproductive technologies (ARTs) often used to treat infertility raise ethical issues including informed consent, veracity, and nonmalificence. In the United States, there is the need to improve maternal and fetal/neonatal mortality and morbidity by proposing legislation regulating ART and supporting single embryo transfers with no more than 2 such transfers. Beginning with the diagnosis of infertility, providers have a responsibility to educate, inform, and treat infertile couples. From the moment pregnancy with multiples is confirmed, these families are faced with incredible stressors including decision making on multifetal or selective reduction. Full disclosure of risks involved throughout the course of care should be discussed and documented in the record and plan of care. Currently in the United States, legislation does not regulate ART, including ovulation induction/enhancement and in vitro fertilization. Although the United States does have self-regulation via limited reporting through their professional organization and the Centers for Disease Control and Prevention, an unlimited number of embryos may be transferred. Unfortunately, many healthcare providers have not recognized the responsibility and burden placed on families and society as a whole. Lack of regulation means women may become pregnant with high order multiples, which raises serious moral and ethical issues.

Beneficence↗