To tell or not to tell: breaching confidentiality with clients with HIV and AIDS

A Social-Identity Theory of Information-Access Regulation (SITIAR): Understanding the Psychology of Sharing and Withholding

Secrecy, privacy, confidentiality, concealment, disclosure, and gossip all involve sharing and withholding access to information. However, existing theories do not account for the fundamental similarity between these concepts. Accordingly, it is unclear when sharing and withholding access to information will have positive or negative effects and why these effects might occur. We argue that these problems can be addressed by conceptualizing these phenomena more broadly as different kinds of information-access regulation. Furthermore, we outline a social-identity theory of information-access regulation (SITIAR) that proposes that information-access regulation shapes shared social identity, explaining why people who have access to information feel a sense of togetherness with others who have the same access and a sense of separation from those who do not. This theoretical framework unifies diverse findings across disparate lines of research and generates a number of novel predictions about how information-access regulation affects individuals and groups.

Is it acceptable for a psychiatrist to break confidentiality to prevent spousal violence?

STUDY QUESTION

When is it acceptable for a psychiatrist to break confidentiality to protect the wife of a potentially violent patient?

METHODS

153 lay persons, 13 nursing personnel, 10 physicians, and 10 psychologists in France indicated this acceptability in 48 scenarios. The scenarios were all combinations of 5 factors: gravity of threat (death or beating), certainty of mental illness (certain or not), time spent talking with patient (considerable or little), his attitude toward psychotherapy (rejection, indecision, or acceptance), and whether the physician consulted an expert.

RESULTS

Lay people favored breaking confidentiality more than did nursing personnel or psychologists. Consulting an expert had greatest impact. Lay participants were composed of groups that found breaking confidentiality "always acceptable" (22 participants), "depending on many circumstances" (106), requiring "consultation with an expert" (31), and "never acceptable" (27).

CONCLUSION

Lay people in France are influenced by situational factors when deciding if a psychiatrist should break confidentiality to protect a patient's wife.

Understanding Hope in the Face of an HIV Diagnosis and High-risk Behaviors

The purpose of this article is to: (a) explore and describe experiences of hope in the context of high-risk behaviors; and (b) identify sources of hope for participants dealing with an HIV diagnosis. Following qualitative case study methodology along with philosophical hermeneutics, 12 people diagnosed with HIV or AIDS were interviewed to understand their experiences of hope. Participants were selected based on self-report for continuing or increasing high-risk behaviors following diagnosis. Results include participant descriptions of hope as well as five higher order categories that highlight sources of hope following an HIV diagnosis. Implications for treatment of those newly diagnosed and engaged in high-risk behaviors are discussed.

Timing invitations to participate in clinical research: preliminary versus informed consent

This article addresses the impact of the potential conflict between the roles of physicians who are both clinicians and researchers on the recruitment of persons into research trials. It has been proposed (1) that a physician breaches inter-role confidentiality when he or she uses information gathered in his or her clinical role to inform patients about trials for which they may be eligible and (2) that clinician-researchers should adopt a model of preliminary consent to be approached about research prior to commencing a clinical relationship. This article argues that even if we grant the legitimacy of inter-role confidentiality (which is open to question), there are circumstances in which other obligations physicians bear override the obligation of inter-role confidentiality. Moreover, it is argued that the practice of preliminary consent is morally suspect and that such consent cannot be deemed valid. The article concludes with a series of recommendations of ways in which the legitimate concern regarding the conflicting roles of clinician-researchers can be addressed in the recruitment stage of research.