Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Truth Disclosure”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,495 records · Page 83Linked to original sources
PubMed2000

Medicolegal and ethical issues in genetic cancer syndromes.

Physicians whose patients may be affected by genetic cancer syndromes must be sensitive to a range of legal and ethical concerns. We provide an overview of the major issues, focusing on developments in the United States. The first section examines the physician's legal and ethical duties to the patient. A number of general rules are advanced, including: 1) genetic counseling should be offered to those considering genetic testing; 2) a genetic test should not be performed without the patient's informed consent; and 3) genetic information should not be disclosed to third parties without the patient's written authorization. Laws addressing genetic testing and disclosure of information are reviewed, as well as laws addressing genetic discrimination. Physicians must be aware that the availability of legal protections may affect a patient's willingness to undergo testing. Next, we examine the physician's duty to the patient's family. Where a conflict exists between the interests of the patient and the interests of family members, ethics and current law favor the interests of the patient, absent unusual circumstances. Further, we provide guidance on the scope of the physician's duty to inform, e.g., whether the physician must inform the patient of all medically reasonable treatment options, including those with which the physician disagrees. Finally, we discuss the special ethical and legal issues that prophylactic surgery raises. Areas covered include informed consent and insurance coverage. Several recent cases involving these issues are reviewed.

Confidentiality↗
PubMed1997

The psychological impact of withholding disclosure of child sexual abuse.

Researchers have found equivocal results with respect to whether the disclosure of child sexual abuse is helpful or not. The threat of harm as well as the possibility of being humiliated, not believed, or blamed, render the disclosure of child sexual abuse difficult for some victims. Suppressing of traumatic events has been linked to negative health effects. The current study investigated the relationship between the inability to fully disclose the abuse and subsequent traumatic symptomatology. Questionnaires including the Trauma Symptom Checklist 40, the Child Sexual Experiences Questionnaire, and the Parental Support Scale were completed by 204 victims of child sexual abuse. Multiple regression analyses were performed using traumatic symptomatology as the dependent variable. The extent to which a victim wanted to tell about the abuse but held back from doing so and the severity of the abuse were related to adult symptomatology. Findings suggest that victims enduring more severe abuse are more likely to hold back from fully disclosing the abuse which is associated with more trauma-related symptoms.

Adolescent↗
PubMed1997

Psychological aspects of cancer surgery: surgeons' attitudes and opinions.

Fifty-one surgical consultants, registrars and senior registrars in NHS hospitals in the West Midlands (UK) were interviewed about psychological aspects of cancer surgery: information given to patients, the bad news interview, psychological risk factors in surgery, psychiatric morbidity, difficult patients, and care of the dying. Information that tended to be provided infrequently included the cause of the disease, the effects of surgery on sexual functioning, and psychological side-effects of the surgery. Surgeons most often answered incompletely patients' questions about prognosis, effects of surgery on sexual functioning, the presence of malignancy, and probable length of life. Concerning the disclosure of malignancy, 37% said they always tell the patient; 8% tell virtually all patients; 49% tell the patient depending on the patient's and relatives' wishes; and 6% tell the relatives and possibly the patient. A common strategy among 49% is to use the word 'growth' and wait for the patient to ask further. Few surgeons took even the briefest psychiatric history, and only the most severe post-operative psychological complications were referred to psychiatrists. The most difficult patients for surgeons to manage were emotionally labile, angry, demanding, controlling, refusing treatment, or predicting failure. The surgeons in this sample clearly struggled with their role as giver of bad news and with the consequent emotional reactions of the patient.

Attitude of Health Personnel↗
PubMedDate not supplied

Strategies of information disclosure to Chinese cancer patients in an Asian community.

There is little information available on strategies of information disclosure used by doctors in the care of patients with cancer. This report focuses on the style of disclosure used by doctors when giving diagnostic and prognostic information to patients with cancer. Among 46% of 133 surgeons and radiotherapists interviewed, disclosure of diagnosis involved a sudden approach (information given outright at one sitting). Less commonly used (19%) was a gradual disclosure style. Of the remainder who disclosed, more than half did so through the family or left it to the family to tell the patient. Doctors' specialty and patients' requests for prognostic information dictated disclosure style most frequently. Single people were more likely to have information disclosed to their families than were married people. While anecdotal accounts indicate negative reactions on the part of patients are a major reason for withholding such information, different disclosure style had little effect on doctors' reports of patient reactions to the bad news. Doctors perceived 25% of patients appeared to react 'with depression' but the remaining 75% appeared 'calm'. These results suggest patients are more likely to be told bad news suddenly, and that doctors do not perceive that this impacts too negatively on patients. The high levels of reported preference for information about cancer in Hong Kong (Fielding and Hung, 1996) conflict with actual prevalence patterns. It seems that commonly cited anecdotal reasons for withholding information from cancer patients in Hong Kong are not sustained by the data produced in these studies.

Adolescent↗
PubMed2003

[European survey on current practice and disclosure of the diagnosis of Alzheimer's disease. A study based on caregiver's report].

UNLABELLED: The disclosure of a diagnosis of Alzheimer's disease is a complex and critical event. The aim of this study initiated by the Association Alzheimer-Europe was to explore 1) the context of the establishment of the diagnosis and the circumstances of its disclosure 2) the impact of the disclosure of the diagnosis on the patients and the caregivers 3) the amount and the adequacy of information provided by the physicians to the patients and the caregivers compared to their needs. Subjects. 323 caregivers were recruited through family associations in 11 European countries. METHODS: Data were collected using a structured questionnaire filled in by the caregivers. RESULTS: The caregivers' profile broadly was similar to that found in the published literature. The initial symptoms noted by the family members were memory disorders and behavioral manifestations, both in 50% of cases and isolated each in approximately 25%. Half of the carers reported a delay of one year or more between the initial symptoms and the first medical examination. The diagnosis was made mostly by neurologists, but also by psychiatrists, geriatricians, general practioners or neuropsychologists in various proportions according to the different countries. The diagnosis was disclosed in front of the patients only in approximately half of the cases. When the diagnosis was disclosed to the family alone, 56% of the carers did not want the diagnosis to be disclosed to the patients. Negative reactions of the carers to the disclosure of the diagnosis were clearly linked with the physician's attitude and time dedicated to information on the disease and its consequences. 43% of the carers were not satisfied by the information provided by the physicians and there was a discrepancy between the nature of the information provided by the physicians and the needs of the carers. Nearly one third of the patients had no regular follow-up after the diagnosis and 27% did not receive any treatment. CONCLUSION: This study shows important inadequacy in the management and counselling of patients with Alzheimer's disease and their relatives. Consideration should be given to developing a new philosophy of care based on a better understanding between health professionals, patients and families.

Aged↗
PubMed1995

Older children and adolescents living with perinatally acquired human immunodeficiency virus infection.

OBJECTIVE: To describe the clinical, immunologic, and psychosocial characteristics of children living with perinatally-acquired human immunodeficiency virus (HIV) infection beyond the age of 9 years. METHODS: This is a descriptive cohort study of 42 surviving perinatally infected children older than 9 years followed at the Children's Hospital Acquired Immunodeficiency Syndrome (AIDS) Program (part of a university-based inner city medical center) as of June 1993. The study is based on medical record data of clinical, immunologic, and psychosocial parameters. RESULTS: The cohort includes 20 boys and 22 girls with a mean age of 136 months. The mean age at diagnosis of HIV infection was 88 months, and 59.5% were asymptomatic at the time of diagnosis. Currently, after a mean follow-up period of 48 months from diagnosis, 23.8% remain asymptomatic, 19.1% have non-AIDS-defining HIV-related symptoms, and 57.1% have AIDS; 85.7% of the cohort did not develop HIV-related symptoms until after 48 months of age (late-onset prolonged survivors). There was an average annual decline of 71.4 CD4+ cells/microL in the cohort from the ages of 7 to 16 years, and 21.4% have a current CD4+ lymphocyte count of greater than 500 cells/microL, 28.6% between 200 and 500 cells/microL, and 50% less than 200 cells/microL; 76% are orphaned as a result of maternal death, with the majority of the cohort (60%) cared for by extended family members. Disclosure of diagnosis has occurred in 57.1%. The vast majority of the cohort (76%) are attending regular school, with the remainder in special education. CONCLUSIONS: Although close to one quarter of the children and adolescents ages 9 to 16 years living with perinatally acquired HIV infection described in this cohort remain asymptomatic and have a relatively intact immune system, the remainder are living with significant HIV-related symptoms, many of which are chronic in nature and have an impact on daily living. The children in this cohort had both significant immunologic deterioration and symptomatic disease progression during the mean follow-up period of 48 months from the time of diagnosis with HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Assessing antenatal psychosocial health. Randomized controlled trial of two versions of the ALPHA form.

OBJECTIVE: To determine whether participants preferred a provider-completed or self-reported antenatal psychosocial health assessment (ALPHA) form, to evaluate the forms' effectiveness in facilitating disclosure of psychosocial issues, and to determine whether different providers gathered different information. DESIGN: Randomized controlled study. SETTING: Offices of family physicians and public health nurses (PHNs) in three health regions on Prince Edward Island. PARTICIPANTS: Physicians, PHNs, and 76 pregnant women. INTERVENTIONS: Participants completed one form and a questionnaire on theirexperience. Providers were also interviewed. MAIN OUTCOME MEASURES: Suitability and effectiveness of the forms and frequency of issues disclosed by type of form and provider. RESULTS: Most participants would recommend routine use of the ALPHA form for all pregnant women. Of the 238 psychosocial issues disclosed, significantly more were disclosed to physicians than to PHNs. CONCLUSION: Both forms were acceptable to women and providers (no clear preference emerged) and were effective at gathering information. Physicians gathered significantly more information than PHNs.

Adolescent↗
PubMed2007

Barriers and incentives to HIV treatment uptake among Aboriginal people in Western Australia.

OBJECTIVE: To examine the barriers and incentives to HIV treatment uptake among Aboriginal people in Western Australia. METHODS: In-depth, semi-structured interviews were conducted between February and September 2003 with 20 Aboriginal people who were HIV-positive; almost half the total number of Aboriginal people known to be living with HIV in Western Australia at that time. RESULTS: Despite having access to treatments in both urban and rural areas, only 11 of the 20 participants were on antiretroviral treatment at the time of interview. Four of the women had been prescribed treatment during pregnancy only. The main barriers to treatment uptake were fear of disclosure and discrimination, heavy alcohol consumption and poverty. The incentives were pregnancy and access to services whose approach can be described as broad-based and holistic, i.e. supporting people in the context of their everyday lives by providing psychosocial and welfare support as well as healthcare. CONCLUSION: For many Aboriginal people, maintaining social relationships, everyday routines and the respect of friends, families and community is a greater priority than individual health per se. Treatment regimens must be tailored to fit the logistical, social and cultural context of everyday life, and be delivered within the context of broad-based health services, in order to be feasible and sustainable.

Adult↗
PubMed2003

The current role of post-conviction sex offender polygraph testing in sex offender treatment.

Polygraph testing is becoming increasingly important in sex offender treatment. Polygraph advocates cite dramatic increases in historical disclosures that presumably allow more precise targeting of treatment interventions, earlier detection of risky behaviors that often lead to new offenses, and improved treatment and supervision compliance. Based on this, they believe the procedure supports desirable behavior that continues to various degrees after treatment and supervision end. Opponents cite ethical problems related to inaccurate results, unproven accuracy rates, and the risk that examinees may be coerced into making false admissions. To counter these criticisms, proponents have developed standards, best practices, and examiner training and certification programs intended to reduce error rates and address ethical issues. Opponents argue that these measures have not been tested and that empirically established error rates and best practices may not be possible for a variety of reasons. This article reviews the current situation, leaving readers to decide the wisdom and ethics of using polygraph testing in their own practices.

Criminal Law↗
PubMedDate not supplied

Crisis communications moves to front burner.

Crisis communications, or crisis management, moved to the front burner on a national basis following the Tylenol poisonings in the early '80s. It's a fact of life (or death) that day after day, incident after incident, hospital after hospital has to deal with internal problems that become external issues. Balancing disclosure and the media's relentless quest for every available detail with the legal implications involved can test the public relations skills of even the most experienced practitioner. So how do you learn how to handle a crisis situation? There are books available on the topic, there are experts in the field and then there are those who have "been there, done that" and have agreed to share the experiences. Enter Greg McGarry, public relations director at Albany Medical Center in Albany, N.Y. If any hospital PR director has had to deal with a more challenging series of tragic and unusual circumstances in a brutally short timeframe, we have yet to hear about it. As a result of his forthrightness and candidness, backed by a supportive and understanding senior management team, news articles were fair, balanced and included the hospital's position. Even critical editorials included words of praise.

Communication↗
PubMed2003

Serostatus disclosure, sexual communication and safer sex in HIV-positive men.

This study assessed HIV-positive men's sexual behaviours with partners at risk for infection, and examined the extent to which safer sex was associated with interpersonal communication variables, namely, (1). disclosure of one's seropositive status and (2). specific communication with partners about safer-sex practices. A total of 105 HIV-positive men (43% homosexual, 38% bisexual, 19% heterosexual), randomly sampled at an HIV outpatient clinic in Los Angeles, completed a behavioural questionnaire assessing events in their most recent sexual encounter with an HIV-negative or unknown serostatus partner. Results indicated that men who disclosed their seropositive status and explicitly discussed the topic of safer sex with their at-risk partners had a significantly higher prevalence of protected anal or vaginal intercourse than did men who disclosed only. The findings suggest that post-test counselling regarding the importance of disclosing one's seropositive status to sex partners should be augmented by behavioural interventions that enhance seropositive persons' skills in communicating explicitly with partners about safer sex to help reduce transmission of HIV.

Adult↗
PubMed1993

Factors associated with participation in HIV antibody screening and results disclosure.

The Centers for Disease Control reported in October 1991 that many people at risk for human immunodeficiency virus (HIV) infection had not been tested for antibodies to HIV. This study identifies differences among 110 gay and bisexual men in three small cities in Pennsylvania who decided whether to be tested for antibodies to HIV and, if so, whether to return for results. These men were given self-administered questionnaires and were offered free and confidential HIV antibody tests. Fifty percent of the men refused testing. Of those tested, only 35 percent returned to obtain test results. Contrary to other health prevention data, education was significantly and inversely related to being tested and to returning for results. Men who most often participated in the institutionalized gay community were least likely to be tested. The findings suggest that gay men who are most aware of the potential psychosocial problems associated with HIV antibody testing are more likely to avoid testing.

Adolescent↗
PubMed2001

Genetics and the interpersonal elaboration of ethics.

Confidentiality in genetic testing poses important ethical challenges to the current primacy of respect for autonomy and patient choice in health care. It also presents a challenge to approaches to decision-making emphasising the ethical importance of the consequences of health care decisions. In this paper a case is described in which respect for confidentiality calls both for disclosure and non-disclosure, and in which respect for patient autonomy and the demand to avoid causing harm each appear to call both for testing without consent, and testing only with consent. This creates problems not only for clinicians, families and patients, but also for those who propose clinical bioethics as a tool for the resolution of such dilemmas. In this paper I propose some practical ways in which ethical issues in clinical genetics and elsewhere, might be addressed. In particular I call for a closer relationship between ethics and communication in health care decision-making and describe an approach to the ethics consultation that places particular emphasis on the value of interpersonal deliberation in the search for moral understanding. I reach these conclusions through an analysis of the concept of 'moral development' in which I argue that the achievement of moral understanding is a necessarily intersubjective project elaborated by moral persons.

Bioethics↗
PubMedDate not supplied

Epilepsy, driving laws, and patient disclosure to physicians.

To avoid loss of driving privileges, patients with epilepsy may elect not to report seizures to their physician or to the Department of Motor Vehicles (DMV). Reporting to the physician may differ depending upon the type of law in effect, i.e., mandatory physician reporting versus patient reporting to the DMV. Nondisclosure to the physician may have important consequences with regard to seizure management. We surveyed patients at two adult seizure clinics to determine the effect of driving laws on patients' reporting to their physician. One hundred fifty-eight patients completed an anonymous questionnaire asking whether they would report a breakthrough seizure under a physician versus a patient DMV reporting system. Under patient reporting, 96% would inform their physician and 56% would report to the DMV. Under physician reporting, 84% would inform their physician. This falls to 72% when considering currently driving patients only. An additional 9-17% of patients would continue to drive with a suspended license. In all, 53% would remain driving under patient reporting and 33% under physician reporting; however, with physician reporting, half of the illegally driving patients would have compromised their medical care, potentially increasing driving risk.

Automobile Driver Examination↗
PubMed1997

The impact of illness disclosure and custody plans on adolescents whose parents live with AIDS.

OBJECTIVES: To describe the disclosure and custody planning of parents living with AIDS and the impact of these on their adolescents' adjustment. METHODS: An examination of the association of multiple behaviour problems in children and the illness disclosure and custody plans of their parents living with AIDS. RESULTS: Both mothers (87%) and fathers were significantly more likely to disclose their HIV serostatus to adolescents (73%), compared with younger children (23%); only 44% disclosed their illness to all their children; 11% disclosed to none. Most parents (80%) living with AIDS had discussed their custody plans. However, only 30% initiated legal plans, typically for younger children. Adolescents who were informed of their parents' serostatus engaged in more sexual risk acts, smoked more cigarettes, and reported more severe substance use and greater emotional distress than uninformed adolescents. Legal custody arrangements were not associated with adolescent adjustment at recruitment or follow-up. CONCLUSIONS: A longitudinal analysis of the impact on adolescents of the behaviours of parents living with AIDS is needed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

A survey regarding the disclosure of the diagnosis of cancer in Toyama Prefecture, Japan.

A survey regarding the revelation of the diagnosis of cancer to patients was conducted on 116 medical doctors (MD), 206 paramedical personnel (PP) and 789 lay persons (LP) in June 1989 in Toyama prefecture, Japan. When asked in the case that their parents or spouse had cancer, only 29.8% of all respondents answered that they would reveal the diagnosis of cancer to their family member. On the contrary, if they themselves had cancer, 56.3% of all respondents answered that they wished the diagnosis to be revealed, and 77.4% of these answered that they wished to be informed of the cancer diagnosis by the doctor in charge. They wanted to know the details of their condition from their medical doctor, and thought that they could receive this knowledge calmly. Thirty-one percent (34/108) of the doctors questioned reveal the diagnosis of cancer to their patients and 79.4% of these answered that they felt that telling the true diagnosis was good. A serious responsibility for the medical doctor was indicated.

Adult↗
PubMed1998

Proposed amendments to Summary Plan Description Regulations--Department of Labor. Notice of proposed rulemaking.

This document contains proposed amendments to the regulations governing the content of the Summary Plan Description (SPD) required to be furnished to employee benefit plan participants and beneficiaries under the Employee Retirement Income Security Act of 1974, as amended, (ERISA). These amendments are being proposed to implement information disclosure recommendations of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, as set forth in their November 20, 1997 report "Consumer Bill of Rights and Responsibilities," by clarifying benefit, medical provider and other information required to be disclosed in, or as part of, the SPD of a group health plan and for other reasons as well. This document also contains a proposed amendment to repeal the limited exemption with respect to SPDs of welfare plans providing benefits through qualified health maintenance organizations (HMOs). In addition, the Department is proposing a number of amendments to the SPD content regulation that are intended to update and clarify the application of provisions affecting both pension and welfare benefit plans. The amendments contained in this document will affect employee pension and welfare benefit plans, including group health plans, as well as administrators, fiduciaries, participants and beneficiaries of such plans.

Eligibility Determination↗
PubMed1987

Patient warnings in court-ordered evaluations of children and families.

The rules covering disclosure of information generated by court-ordered clinical evaluations in Massachusetts require that patients be warned that the patient-psychotherapist privilege does not apply to the evaluation interview. The nature of the warning required ("the Lamb warning") is not perfectly clear and is especially uncertain when those being warned are children and families. Comparing the Lamb warning to the Miranda warning offers some insight but is not conclusive. To reach conclusions regarding the type and degree of procedural protections for children required by the Lamb warning, it is necessary to analyze the stakes, interests, and capacities involved for children in juvenile court. This analysis suggests that in most situations a relatively informal procedure is sufficient to provide the required warning. However, there are some exceptional circumstances in which more formal and thorough warnings should be required. These include juvenile transfer hearings and some situations involving child abuse and neglect.

Adolescent↗