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Atencion Primaria May 2021
Topics: Biomedical Research; COVID-19; Disclosure; Humans; Publishing; Uncertainty
PubMed: 33756259
DOI: 10.1016/j.aprim.2021.102015 -
JAMA Ophthalmology May 2019Beside the goal of increasing transparency to the public, disclosure policies and laws have been established with a goal to also reduce ethically questionable financial...
IMPORTANCE
Beside the goal of increasing transparency to the public, disclosure policies and laws have been established with a goal to also reduce ethically questionable financial relationships between physicians and the medical industry. Data on these relationships should be reviewed to understand the association between these policies and laws and the attainment of reduced relationships.
OBJECTIVE
To assess whether disclosure policies and laws have been associated with a decrease in financial disclosure reporting by physicians.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study uses yearly data from 2008 through 2015 from the participants in the American Academy of Ophthalmology's Annual Meeting. Trends in financial disclosures over time were investigated for the association of disclosure policies and laws with potentially beneficial, as well as ethically questionable physician-industry ties. Linear regression models were used to estimate the annual change in financial disclosures and are reported with 95% CIs.
EXPOSURES
Disclosure policies and laws.
MAIN OUTCOMES AND MEASURES
The annual aggregate financial disclosures by type (ie, consultant, lecturer, employee, grant support, equity owner, patent holder).
RESULTS
Financial disclosures increased from 3966 in 2008 to 5266 in 2015 (P < .001). The number of disclosures reported in the categories consultant, equity owner, patents, and grant support all increased from 2008 to 2015 (consultant disclosures, 121 [95% CI, 88-155] per year; P < .001; equity owner disclosures, 32 [95% CI, 22-42] per year; P < .001; patent disclosures, 19 [95% CI, 13-26] per year; P < .001; grant support disclosures, 78 [95% CI, 48-107] per year; P < .001), while the employee and lecturer categories did not change significantly. The percentage of financial disclosures in the lecturer category decreased relative to the total (estimate, -1.1% [95% CI, -1.3% to -0.8%] per year; P < .001), owing to the number of financial disclosures for this category remaining stable while most other types increased.
CONCLUSIONS AND RELEVANCE
Disclosure was not associated with a chilling effect (decrease in financial disclosures associated with potentially beneficial physician-industry ties). Disclosure was associated with a possible disinfecting effect, whereby the percentage of ethically questionable disclosures (ie, lecturers) decreased, although the frequency remained stable. A permissive effect (physicians becoming more inclined to having industry relationships) was also observed. Thus, disclosure rules should be enhanced or alternative approaches to disclosure reconsidered to promote a decrease in ethically questionable relationships.
Topics: Conflict of Interest; Cross-Sectional Studies; Disclosure; Humans; Industry; Physicians; United States
PubMed: 30816947
DOI: 10.1001/jamaophthalmol.2019.0085 -
AMA Journal of Ethics Jun 2016The past two decades have marked an increase in research on the prodromal stages of schizophrenia that precede a first episode of psychosis. Criteria for a clinical high... (Review)
Review
The past two decades have marked an increase in research on the prodromal stages of schizophrenia that precede a first episode of psychosis. Criteria for a clinical high risk (CHR) state for psychosis have been validated and included in the DSM-5 as the attenuated psychosis syndrome and as requiring further study. This was hotly debated, given the concern of stigmatizing young people who would receive this psychosis risk label. In this article, I review ethical issues related to the psychosis risk label, including the potential harm of stigma and paternalism if risk labels are withheld in the context of the observed low predictive power of the psychosis risk designation. I review data that supports that the psychosis risk label need not be harmful, and could even confer benefit, and set out strategies for reducing stigma through individualized risk assessment and public health education.
Topics: Communication; Disclosure; Ethics, Medical; Humans; Prodromal Symptoms; Psychotic Disorders; Schizophrenia; Social Stigma; Stereotyping
PubMed: 27322997
DOI: 10.1001/journalofethics.2016.18.6.msoc2-1606 -
Reproductive Health Dec 2019Domestic violence is common public health problem. Domestic violence related disclosure is an important first step in the process of prevention, control and treatments... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Domestic violence is common public health problem. Domestic violence related disclosure is an important first step in the process of prevention, control and treatments of domestic violence related adverse effect. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of domestic violence related disclosure and synthesize its associated factors.
METHODS
We followed the PRISMA Guidelines to report the results of the finding. Databases including PubMed, Cochrane Library and Web of Sciences were searched. The heterogeneity between studies was measured by the index of heterogeneity (I statistics) test. Funnel plots and Egger's test were used to determine publication bias. Moreover, sensitivity analysis was carried out. To calculate the pooled prevalence, a random effects model was utilized.
RESULTS
Twenty one eligible studies were included in this systematic review and meta-analysis. The pooled prevalence of domestic violence related non-disclosure was found to be 36.2% (95% CI, 31.8-40.5%). Considering violence as normal or not serious, shame, embarrassment and fear of disclosure related consequences were the common barriers for non-disclosure.
CONCLUSION
More than one third of women and girls were not disclosed their experience of domestic violence. The finding of this study suggests the need of evaluation and strengthening of the collaborative work among different sectors such as: policy-makers, service providers, administrative personnel and community leaders including the engagement of men partner. This study also suggests the needs of women empowerments against the traditional belief, attitude, and practice.
Topics: Adolescent; Adult; Disclosure; Domestic Violence; Ethiopia; Female; Humans; Prevalence; Sexual Partners
PubMed: 31870388
DOI: 10.1186/s12978-019-0845-z -
Human Reproduction (Oxford, England) Apr 2023Do the attachment-related dimensions Anxiety and Avoidance and perceived partner and social support in recipients and donors influence disclosure to others about their...
STUDY QUESTION
Do the attachment-related dimensions Anxiety and Avoidance and perceived partner and social support in recipients and donors influence disclosure to others about their involvement in donor-assisted conception (DAC)?
SUMMARY ANSWER
A higher global score on attachment Avoidance was associated with greater non-disclosure about involvement in DAC by participants to relationship-specific others.
WHAT IS KNOWN ALREADY
Within the context of DAC, the topic of disclosure has been investigated in terms of the 'if', 'when', and the 'how' to disclose about circumstances of conception. Less focus, however, has been directed to investigating psychological theoretical frameworks that influence disclosure decisions to others, i.e. to whom information is disclosed and to what extent details are transparently revealed about the donor programme.
STUDY DESIGN, SIZE, DURATION
The study was of a cross-sectional design and utilized a sample of 301 participants who were, or had been, involved in DAC, and were recruited across states of Australia. An online self-report questionnaire was completed between June 2014 and June 2017.
PARTICIPANTS/MATERIALS, SETTING, METHODS
English speaking participants consisting of 209 female recipients and 92 donors (36 sperm; 48 egg; 8 embryo donors). Of the recipients, 104 had successfully conceived children via donated gametes (68 sperm, 23 eggs, 6 embryos, and 7 recipients where both gametes were donated from 2 donors to create the embryo). Participants anonymously completed an online questionnaire consisting of five sections: Demographics, Donor Conception and Disclosure Practices, the Experiences in Close Relationships-Relationships Structure, the Quality of Relationship Inventory, and the Multidimensional Scale of Perceived Social Support. Pearson correlations, independent samples t-tests, Chi-square, and ANOVA were used to explore the association between attachment Anxiety and Avoidance scores and disclosure about involvement in a DAC programme to significant others (i.e. parents, siblings, in-laws, and friends).
MAIN RESULTS AND THE ROLE OF CHANCE
Compared to published community cohort data, participants reported lower global scores on attachment Anxiety and Avoidance and high levels of romantic partner and social network support, suggestive of secure relationships in the overall study sample. A higher score on attachment Avoidance was associated with less disclosure to significant others in their social network (i.e. parents, siblings, in-laws, and close friends), even in the presence of strong partner support (partial r = -0.248, P = 0.005). Higher scores on attachment Avoidance were inversely associated with level of perceived partner and social network support (all P < 0.05). Irrespective of attachment scores, more than 90% of all participants agreed that a child born of DAC should be told about mode of conception.
LIMITATIONS, REASONS FOR CAUTION
This study utilized a cross-sectional design precluding causal inferences between dimensions of insecure attachment and disclosure practices. Participants were required to self-report on the quality of their relationships with the potential for social desirability respondent bias. The study's self-selecting sample may limit generalization to participants who were dis-inclined to participate. Specifically, respondents who have an Avoidant attachment style, may have elected not to participate in the study.
WIDER IMPLICATIONS OF THE FINDINGS
Given the increased use of biotechnology and digital facial recognition enabling self-discovery of the donor and the donor's extended family, non-disclosure about involvement in DAC may have consequences. An 'Avoidant' attachment style is important to assess as a potential risk factor for non-disclosure about involvement in DAC across different relational contexts (e.g. close family members and friends). Fertility counsellors should consider introducing a measure of attachment screening as a pre-emptive psychoeducational strategy during donor implications counselling. This information could be used to offer patients insight into concerns they have about DAC disclosures to key important relationships, providing a target of clinical intervention.
STUDY FUNDING/COMPETING INTEREST(S)
No external funds were sought for this work. None of the authors have any competing interests to declare.
TRIAL REGISTRATION NUMBER
N/A.
Topics: Child; Humans; Male; Female; Donor Conception; Cross-Sectional Studies; Friends; Semen; Disclosure
PubMed: 36737051
DOI: 10.1093/humrep/dead019 -
Canadian Medical Education Journal Jun 2023
Topics: Truth Disclosure; Communication
PubMed: 37465734
DOI: 10.36834/cmej.76145 -
JAMA Dermatology Dec 2021This survey study used data from a 2020 American Academy of Dermatology member satisfaction survey to assess lesbian, gay, bisexual, and transgender identity and...
This survey study used data from a 2020 American Academy of Dermatology member satisfaction survey to assess lesbian, gay, bisexual, and transgender identity and disclosure among US dermatologists.
Topics: Bisexuality; Dermatologists; Disclosure; Female; Humans; Sexual and Gender Minorities; Transgender Persons
PubMed: 34757403
DOI: 10.1001/jamadermatol.2021.4544 -
PloS One 2023Non-profit organizations (NPOs) help the state achieve its social objectives. At the same time, they often depend on the private-sector actors for donations. The...
Non-profit organizations (NPOs) help the state achieve its social objectives. At the same time, they often depend on the private-sector actors for donations. The different beliefs of public- and private-sector actors regarding which practices are desirable for NPOs can affect the transparency of these organizations. We propose that political ties influence NPOs to comply with state-mandated disclosure requirements, while simultaneously dampening their willingness to voluntarily disclose sensitive information that may jeopardize their legitimacy in the eyes of private-sector stakeholders. The impact of political ties on disclosure is contingent upon two factors. First, market institutions moderate such effects because expectations of public- and private-sector actors may diverge more in freer markets than where the state has inordinate power. Second, financial dependence on the state amplifies both effects as dependence on the state exerts more pressure for compliance whilst making politically connected organizations appear even more questionable in the eyes of the private-sector stakeholders. Leveraging a policy shock that weakened political ties, we found that following the policy shock, charities in China reduced their compliance to state-mandated information disclosure, but increased their voluntary disclosure. The opposing roles of political ties in mandatory versus voluntary disclosure is further supported by a policy capturing study involving private donors in China. This study has important implications for research on political ties and information disclosure.
Topics: Disclosure; Organizations; Organizations, Nonprofit; China
PubMed: 37506088
DOI: 10.1371/journal.pone.0289016 -
Academic Medicine : Journal of the... Jun 2014Evolving state law, professional societies, and national guidelines, including those of the American Medical Association and Joint Commission, recommend that patients...
Evolving state law, professional societies, and national guidelines, including those of the American Medical Association and Joint Commission, recommend that patients receive transparent communication when a medical error occurs. Recommendations for error disclosure typically consist of an explanation that an error has occurred, delivery of an explicit apology, an explanation of the facts around the event, its medical ramifications and how care will be managed, and a description of how similar errors will be prevented in the future. Although error disclosure is widely endorsed in the medical and nursing literature, there is little discussion of the unique role that the physician assistant (PA) might play in these interactions. PAs are trained in the medical model and technically practice under the supervision of a physician. They are also commonly integrated into interprofessional health care teams in surgical and urgent care settings. PA practice is characterized by widely varying degrees of provider autonomy. How PAs should collaborate with physicians in sensitive error disclosure conversations with patients is unclear. With the number of practicing PAs growing rapidly in nearly all domains of medicine, their role in the error disclosure process warrants exploration. The authors call for educational societies and accrediting agencies to support policy to establish guidelines for PA disclosure of error. They encourage medical and PA researchers to explore and report best-practice disclosure roles for PAs. Finally, they recommend that PA educational programs implement trainings in disclosure skills, and hospitals and supervising physicians provide and support training for practicing PAs.
Topics: Disclosure; Health Policy; Humans; Medical Errors; Patient Care Team; Physician Assistants; Practice Guidelines as Topic; Professional-Patient Relations; Societies; United States
PubMed: 24871235
DOI: 10.1097/ACM.0000000000000261 -
The British Journal of General Practice... Sep 2015There is a debate in medicine about the value of self-disclosure by the physician as a communication tool. (Review)
Review
BACKGROUND
There is a debate in medicine about the value of self-disclosure by the physician as a communication tool.
AIM
To review the empirical literature of self-disclosure in primary care.
DESIGN AND SETTING
Systematic review of empirical literature relating to self-disclosure by primary care physicians (including US paediatricians) from seven electronic databases (MEDLINE(®), Scopus, PsycINFO, Embase, Social Sciences Citation Index, EBSCOhost, and Cochrane Central Register of Controlled Trials [CENTRAL]).
METHOD
Databases were searched for empirical studies on self-disclosure and primary care published from 1946 to 28 November 2014, as well as references from primary studies. The search was extended to include working papers, theses, and dissertations.
RESULTS
Nine studies were identified, with response rates ranging from 34% to 100%, as well as several not reported. Self-disclosure occurred in 14-75% of consultations, the most from paediatricians. Self-disclosure had intended benefit; however, one standardised patient study found that 85% of self-disclosures were not useful as reported by the transcript coders. Conflicting data emerged on the self-disclosure outcome.
CONCLUSION
This is the first systematic review of self-disclosure in primary care and medicine. Self-disclosure appears to be common and has the potential to be helpful when used judiciously. Few studies examined the impact on patients, and no studies considered the individual patient perspective nor the content which results in benefit or harm. No evidence was found of any training into how to deal with self-disclosure.
Topics: Communication; Disclosure; Humans; Physician-Patient Relations; Physicians, Primary Care; Primary Health Care
PubMed: 26324498
DOI: 10.3399/bjgp15X686533