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This paper explores contemporary approaches to balancing truth with the provision of hope during the disclosure of a dementia diagnosis. We discuss the ethical significance of these practices as they relate to each member of the triad – the person, the carer and the clinician – at the point of diagnosis and beyond. The process of disclosing a diagnosis of dementia is complex. It encompasses breaking bad news while balancing hope, with truth about a progressive life-limiting condition. The process of receiving the diagnosis likewise challenges the person who may be unprepared for the diagnosis, while carers seek information and supports. The impact of receiving a diagnosis of dementia can be life-changing and harmful at the personal level – for both the person and carer. This risk of harm becomes a critical consideration for clinicians when deciding on the level of truth: what information should be relayed and to whom? That risk is also balanced against the ethical issue of patient autonomy, which includes the right to know (or not) and make informed decisions about therapeutic interventions. While the consensus is that the autonomy of the person living with dementia must be upheld, controversy exists regarding the extent to which this should occur. For instance, at diagnosis, it is common for clinicians to use euphemisms rather than the word dementia to maintain hope, even though people and carers prefer to know the diagnosis. This practice of therapeutic lying is a pervasive ethical issue in dementia care, made more acceptable by its roots in diagnosis disclosure.

Funder: Defense Advanced Research Projects Agency; FundRef: https://doi.org/10.13039/100000185, Funder: Winton Centre for Risk & Evidence Communication, Funder: David & Claudia Harding Foundation, As part of the Systematizing Confidence in Open Research and Evidence (SCORE) program, the present study consisted of a two-stage replication test of a central finding by Pennycook et al. (2020), namely that asking people to think about the accuracy of a single headline improves "truth discernment" of intentions to share news headlines about COVID-19. The first stage of the replication test (n = 701) was unsuccessful (p = .67). After collecting a second round of data (additional n = 882, pooled N = 1,583), we found a small but significant interaction between treatment condition and truth discernment (uncorrected p = .017; treatment: d = 0.14, control: d = 0.10). As in the target study, perceived headline accuracy correlated with treatment impact, so that treatment-group participants were less willing to share headlines that were perceived as less accurate. We discuss potential explanations for these findings and an unreported change in the hypothesis (but not the analysis plan) from the preregistration in the original study.

With age, children become increasingly likely to make initial disclosures of transgressions, such as maltreatment, to peers. The present study examined adults’ credibility evaluations of children’s disclosures to peers across two studies. Study 1 examined credibility evaluations when children disclosed (or concealed) to a peer compared to an adult. Study 2 examined credibility ratings when children disclosed consistently or inconsistently across peer and adult interviews. Children were interviewed by a same-age peer and an adult regarding an event where an adult confederate spilled water on a laptop and broke it. In Study 1, participants heard a child interviewed by either a same-age peer or adult. In Study 2, participants heard a child interviewed by both the same-age peer and adult. In both studies, participants evaluated the child’s credibility. Children who disclosed the transgression were rated as significantly less credible than those who concealed the transgression; however, credibility ratings did not differ by whether the child was interviewed by a peer or adult (Study 1). Furthermore, children who concealed the transgression across both interviews were rated as significantly more credible than children who disclosed in both interviews or disclosed to the peer, but not the adult, interviewer (Study 2). The current study provides the first evidence that peer disclosures may hinder children’s credibility and that adults may be hesitant to believe children’s disclosures of an adult’s transgression.

A diagnosis of genital herpes may result in psychological as well as physical morbidity. Many patients require on-going help and contact the Herpes Viruses Association (HVA), a UK patient support organisation. The HVA conducts occasional questionnaires relating to various issues surrounding herpes and this study reports on a survey conducted amongst members in 2015. The survey was done using SurveyMonkey and covered diagnosis/treatment, both allopathic and self-help, physical and psychological impact and disclosure to partners. Three hundred and fifty-eight women and 103 men completed the questionnaire. Male respondents were older than women (48.6 versus 42.9 years). The majority were first diagnosed in sexual health clinics. A high proportion had informed partners about the diagnosis and in 83% disclosure did not result in rejection. 57% were taking prophylaxis with more taking treatment episodically rather than continually; 11.3% sourced medications on-line. Alternative treatments were used commonly with Lomaherpan cream ( Melissa officinalis), lidocaine ointment and a diet with reduced arginine and increased lysine the most frequent choices. Other alternative treatments included olive leaf extract, Eleuthercoccus senticosus and vitamin supplements. Women reported being troubled psychologically more than men. Neuropathic pain was reported by 80.4% of the women and 64.1% of the men. Although antiviral treatment is cheap and well-tolerated it is still being refused by some healthcare providers. There still appears to be a considerable degree of stigma experienced by patients which can be mitigated by support from patients’ support groups such as the HVA.

Background: Error communication includes both reporting errors to superiors and disclosing their consequences to patients and their families. It significantly contributes to error prevention and safety improvement. Yet, some errors in intensive care units are not communicated. Objectives: The aim of the present study was to explore factors affecting error communication in intensive care units. Design and participants: This qualitative study was conducted in 2019. Participants were 17 critical care nurses purposively recruited from the intensive care units of 2 public hospitals affiliated to Iran University of Medical Sciences, Tehran, Iran. Data were collected through in-depth semi-structured interviews and were analyzed through the conventional content analysis method proposed by Graneheim and Lundman. Ethical considerations: The Ethics Committee of Iran University of Medical Sciences, Tehran, Iran approved the study (code: IR.IUMS. REC.1397.792). Participants were informed about the study aim and methods and were ensured of data confidentiality. They were free to withdraw from the study at will. Written informed consent was obtained from all of them. Findings: Factors affecting error communication in intensive care units fell into four main categories, namely the culture of error communication (subcategories were error communication organizational atmosphere, clarity of processes and guidelines, managerial support for nurses, and learning organization), the consequences of errors for nurses and nursing (subcategories were fear over being stigmatized as incompetent, fear over punishment, and fear over negative judgments about nursing), the consequences of errors for patients (subcategories were monitoring the effects of errors on patients and predicting the effects of errors on patients), and ethical and professional characteristics (subcategories were ethical characteristics and inter-professional relationships). Discussion: The results of this study show many factors affect error communication, some facilitate and some prohibit it. Organizational factors such as the culture of error communication and the consequences of error communication for the nurse and the patient, as well as individual and professional characteristics, including ethical characteristics and interprofessional relationship, influence this process. Conclusion: Errors confront nurses with ethical challenges and make them assess error consequences and then, communicate or hide them based on the results of their assessments. Health authorities can promote nurses’ error communication through creating a supportive environment for them, developing clear error communication processes and guidelines, and providing them with education about the principles of ethical practice.

According to numerous research studies, when adults hear a statement twice, they are more likely to think it is true compared with when they have heard it only once. Multiple theoretical explanations exist for this illusory-truth effect. However, none of the current theories fully explains how or why people begin to use repetition as a cue for truth. In this preregistered study, we investigated those developmental origins in twenty-four 5-year-olds, twenty-four 10-year-olds, and 32 adults. If the link between repetition and truth is learned implicitly, then even 5-year-olds should show the effect. Alternatively, realizing this connection may require metacognition and intentional reflection, skills acquired later in development. Repetition increased truth judgments for all three age groups, and prior knowledge did not protect participants from the effects of repetition. These results suggest that the illusory-truth effect is a universal effect learned at a young age.

Although abuse prevention programs have proliferated, little research has explored the direct effects of such programs on actual child sexual abuse disclosure rates, and no research has explored the effects of such programs on child sexual abuse substantiation. Employing a quasi-experimental design, the present research reflects an exploration of the effects of exposure to the Think First and Stay Safe™ abuse prevention program on abuse disclosure rates of 319 children who underwent a child forensic interview within 2015–2018 in a Midwestern child advocacy center. Supporting our mediational hypotheses, children exposed (vs. not exposed) to the Think First and Stay Safe™ program were significantly more likely to disclose abuse during the forensic interview, which in turn predicted significantly increased abuse substantiation likelihood.

BackgroundInformed consent is an essential aspect in medical and surgical practice. Current guidelines from the UK General Medical Council and the Royal College of Surgeons of England do not give a...

Researchers from disciplines of education, health communication, law and risk management, medicine, nursing, and pharmacy examined communication tensions among interprofessional (IP) health care providers regarding medical error disclosure utilizing patient simulation. Using relational dialectics theory, we examined how communication tensions manifested in both individual-provided medical error disclosure and IP team-based disclosure. Two dialectical tensions that health care providers experienced in disclosure conversations were identified: (a) leadership and support, and (b) transparency and protectionism. Whereas these tensions were identified in an IP education setting using simulation, findings support the need for future research in clinical practice, which may inform best practices for various disclosure models. Identifying dialectical tensions in disclosure conversations may enable health communication experts to effectively engage health care providers, risk management, and patient care teams in terms of support and education related to communicating about medical errors.

Background: Schizophrenia is one of the most stigmatized psychiatric disorders, and disclosing it is often a source of stress to individuals with the disorder. The Coming Out Proud (COP) group intervention is designed to reduce the stigma’s negative impact and help participants decide if they want to disclose their disorder. Aims: To assess the effect of the COP intervention in individuals with the diagnosis of schizophrenia. Methods: A pilot study of 3 2-hour group lessons (6–12 participants) per week. Individuals were selected from three specialized outpatient services in São Paulo, Brazil; 46 people were willing to participate, 11 dropped out during the intervention and 4 were excluded due to low intelligence quotient (IQ), resulting in a final sample of 31 participants. Outcomes were assessed before ( T0/baseline) and after ( T1/directly) after the COP intervention, and at 3-week follow-up ( T2/3 weeks after T1). We applied eight scales, of which four scales are analyzed in this article (Coming Out with Mental Illness Scale (COMIS), Cognitive Appraisal of Stigma as a Stressor (CogApp), Self-Stigma of Mental Illness Scale-Short Form (SSMIS) and Perceived Devaluation-Discrimination Questionnaire (PDDQ)). Results: People who completed the COP intervention showed a significant increase in the decision to disclose their diagnosis (22.5% in T0 vs 67.7% in T2). As to the perception of stigma as a stressor, mean values significantly increased after the intervention ( T0 = 3.83, standard deviation ( SD) = .92 vs T2 = 4.44, SD = 1.05; p = .006). Two results had marginal significance: self-stigma was reduced ( T0 = 3.10, SD = 1.70 vs T2 = 2.73, SD = 1.87; p = .063), while perceived discrimination increased ( T0 = 2.68, SD = .55 vs T2 = 2.93, SD = .75; p = .063). Conclusion: This study suggests that the COP group intervention facilitated participants’ disclosure decisions, and the increasing awareness of stigma as a stressor in life may have facilitated their decision to eventually disclose their disorder. The results raise questions that require further analysis, taking sociocultural factors into account, as stigma is experienced differently across cultures.

In this paper, the authors explore three philosophical theories of truth and offer a critique of this foundational area of scholarship for nursing. A brief summary of key ideas related to the three substantial philosophical theories of truth—that is, correspondence, pragmatism, and coherence—serves to highlight various convictions and commitments that facilitate or discourage the growth of nursing knowledge in particular ways. The authors conclude that the coherence theory of truth offers a more inclusive view of truth and best captures and supports the diversity that exists within nursing knowledge and the regulative ideal to which nursing aspires.

Health leaders in organizational governance have a key role in enacting the Truth and Reconciliation Commission’s Calls to Action. This discussion highlights historical and contemporary truths that can underpin action for addressing colonial impacts on Indigenous (First Nations, Metis, and Inuit) health outcomes and healthcare. Emphasis is on white settler roles and responsibilities, where health-related Calls provide a blueprint for health reconciliation leadership. There is broad agreement of the necessity to acknowledge and address key cornerstones of decolonization at individual, intermediary, and organizational stages: racism, white settler power and privilege, and cultural safety. Already existing leadership roles, responsibilities, and inter-organizational networks can form a solid foundation for health leaders to bring the Calls to the table—alongside First Nations, Metis, and Inuit peoples, in meetings, forums, and conferences and in lobbying efforts to influence the structural, systemic shape, and direction of healthcare in Canada.

Many women who disclose a rape encounter victim-blaming responses, which are associated with negative outcomes. The present study examined rape-related shame and experiential avoidance as mediators of the relation between victim-blaming responses to rape disclosure and depression among 103 rape survivors drawn from a community sample. Results revealed that victim-blaming responses were positively associated with depressive symptoms through rape-related shame and experiential avoidance, and shame was indirectly related to depression via avoidance. Findings suggest clinical interventions should focus on rape-related shame and experiential avoidance in targeting depression among rape survivors, and future research should continue to examine how victim-blaming responses to rape disclosure may be related to these factors.

To better understand what and how institutions of higher education (IHEs) communicate information about sexual assault (SA) on their websites, the current cross-sectional descriptive exploratory study analyzed a stratified sample representing 15% of the IHE websites in the United States. Findings show the availability, location, and type of SA information posted on IHE websites differ based on student population and residential character. Large and primarily residential schools are more likely to include SA information, across multiple pages, with a wider informational span than other categories. However, informational gaps are apparent across all websites. Implications for policy and practice are highlighted.

The phenomenon of Internet child sexual abuse (ICSA) has been receiving growing attention over the last decade, and studies have promoted knowledge with respect to the phenomenon’s epidemiology, as well as to characteristics of the victims, perpetrators, and dynamics in these cases. The current retrospective study sought to delve into the disclosure component in cases of ICSA. The sample comprised 52 cases of adolescents who arrived at a child advocacy center (CAC) following ICSA. Analysis of these cases was targeted to capture the multifaceted nature of disclosure using those perspectives that could be documented by the CAC staff—of the practitioners, the adolescents, and their parents. Beyond the descriptive results regarding the victims and the nature of the abuse, the case analyses illustrate the disclosure process as experienced by the various parties involved, highlighting the challenging nature of this aspect of the phenomenon. For the parents, the disclosure experience can perhaps be best epitomized by the expression that was heard repeatedly—“Stop waking the dead”—an expression that indicated their wish to bring the subject to a close. The difficulty in disclosing such incidents was also illustrated by the fact that 20 children in the current sample were reluctant to collaborate during the CAC process. In fact, according to these data, most of the incidents were revealed following a police investigation rather than by a disclosure initiated by the children themselves. Focusing on this specific aspect of ICSA—that is, disclosure—enables a new perspective on it and stresses the need to further study it in such cases. A better understanding of the disclosure experience as it pertains to the individuals involved in cases of ICSA may improve and help modify future prevention and intervention efforts in the field.

Recent drives to facilitate earlier identification of dementia have led to increased memory clinic referrals and diagnoses. This study explored the perspectives of memory clinic doctors on making and delivering diagnoses. Four focus groups were conducted with 13 psychiatrists and two geriatricians in the UK. Transcripts were coded line by line using NVIVO. Thematic analysis identified 39 categories, 18 sub-themes and eight overarching themes. Inter-rater reliability on 31% of the data was 0.89. Increased public awareness of dementia was viewed positively in facilitating access to diagnosis and treatment. Doctors viewed diagnosis as a process and expressed concerns about limited pre-diagnostic counselling and post-diagnostic support. In diagnostic delivery doctors sought to develop a narrative drawing on the patient’s report of symptoms and adjust explanations to patient preferences and awareness. However, tailoring the delivery to the individual patient was challenging when meeting for the first time. These consultations often involved three participants (doctor, patient and relative), who were felt to have differing needs and expectations. Doctors emphasized that delicacy was required in deciding in what could be discussed in front of both parties, however also stressed the importance of explicitly naming ‘dementia’. Efforts were made to balance honesty and hope when discussing prognosis and medication. The work was sometimes emotionally distressing, with limited supervision. Existing communication training was felt to be inadequate for consultations involving triads or people with cognitive impairment. Delivering a dementia diagnosis is a nuanced and challenging task. Negotiating honest descriptions of a life-limiting condition whilst instilling hope is further complicated when cognitive impairment affects comprehension. Misunderstandings at the time of feedback may limit patient opportunities for informed future planning afforded by early diagnosis. Doctors in memory clinics would benefit from evidence based training and supervision to prepare them for these emotionally challenging and complex consultations.

The aim of this study is to systematically review practitioners’ practices and attitudes in regards to communicating a diagnosis of dementia. A systematic search was conducted of Scopus, Web of Science and PubMed for English language original empirical papers. A sequential explanatory mixed studies analysis approach was used. Twenty-five quantitative descriptive, two intervention, six mixed methods descriptive and 21 qualitative studies were included. Pooled analysis showed that 34% of GPs and 48% of specialists usually/routinely tell the person with dementia their diagnosis, and 89% of GPs and 97% specialists usually/routinely tell the family the diagnosis. Euphemistic terms such as ‘memory problems’ are more often used to describe dementia than medical terms. Practitioners’ decision to diagnose and communicate the diagnosis of dementia are influenced by (a) their own beliefs regarding dementia and treatment efficacy and their confidence in diagnosis and communication; (b) patient circumstances including level of awareness, level of severity and family support; (c) the health and social care system including access to specialist and diagnostic services, reimbursement for diagnosis/management and availability of services and (d) cultural norms in relation to dementia including stigma, labels, and common clinical practice. The diagnosis and communication of diagnosis of dementia are intertwined processes and should be concurrently addressed in interventions. Multicomponent approaches to address these practices could include guideline development, practitioner education, anti-stigma public health campaigns, offering post-diagnosis treatments and support and sufficient reimbursement for practitioners for time spent managing dementia.

Introduction: Older Chinese Americans often defer end-of-life care discussions. Researchers sought to explore how to engage older Chinese Americans and their families in end-of-life care discussions and to understand the optimal timing to initiate such discussions. Methods: Individual, semistructured interviews were conducted with 14 community-dwelling older Chinese Americans, 9 adult children, and 7 clinicians. The data were collected and analyzed using focused ethnographic methodology. Results: Older Chinese Americans and their families would discuss end-of-life care when introduced at “optimal times,” which included after-triggering events (e.g., death of loved ones, fall accidents), changes in health status, or advanced age. Discussion: Adult children are not expected to initiate end-of-life care discussions with their parents. Thus, culturally congruent health care that could better engage Chinese Americans in such discussions would be optimized by having clinicians proactively assess their patients’ readiness and initiate such discussion at optimal times.

University students often experience high levels of stress and, in some cases, the stress leads to tragic outcomes. An important question is whether roommates can perceive the level and change in distress in their peers. We examined self- and other-reports of 187 same-sex undergraduate dyads at two times in a spring semester. Using the truth and bias model, we found that roommates tended to underestimate their partner’s distress at both time points, and that ratings were equally influenced by truth and self-focus bias forces. For change, however, there was no evidence of directional (average) bias, and perceived change was only significantly related to the truth force. There were no consistent moderation effects by closeness or gender. These findings are interpreted in the context of person perception theory and the practical need for early warning about extreme distress in college students.

It is increasingly recognised that there are challenges affecting the current delivery of dementia diagnoses. Steps are required to address this. Current good practice guidelines provide insufficient direction and interventions from other healthcare settings do not appear to fully translate to dementia care settings. This project has taken a sequential two-phase design to developing a tool specific to dementia diagnostic delivery. Interviews with 14 participants explored good diagnostic delivery. Thematic analysis produced key themes (overcoming barriers, navigation of multiple journeys and completing overt and covert tasks) that were used to inform the design of a tool for use by clinicians, patients and companions. The tool was evaluated for acceptability in focused group discussions with 13 participants, which indicated a desire to use the tool and that it could encourage good practice. Adaptations were highlighted and incorporated to improve acceptability. Future research is now required to further evaluate the tool.

Disclosure is important in human immunodeficiency virus (HIV) transmission risk reduction. This randomized controlled intervention assessed changes in and predictors of disclosure and risky sexual behavior among Black men who have sex with men (BMSM) living with HIV in the U.S. BMSM were randomly assigned to either the disclosure intervention or attention control case management group. Predictors of three disclosure types (behavior, beliefs, intentions) and condomless anal intercourse (CAI) included disclosure consequences (rewards and costs), disclosure readiness, and safer sex readiness. Mixed-effect results showed no differences between the groups in any of the outcomes; although disclosure behavior increased over time. Relationships were found between readiness to change and CAI; disclosure consequences and different disclosure types; and disclosure behavior and receptive CAI. When working with BMSM living with HIV, practitioners and prevention specialists should consider the importance of disclosure pertaining to receptive CAI and factors that support overall disclosure and safer sex.

Background: Truth-telling toward terminally ill patients is a challenging ethical issue in healthcare practice. However, there are no existing ethical guidelines or frameworks provided for Chinese nurses in relation to decision-making on truth-telling of terminal illness and the role of nurses thus is not explicit when encountering this issue. Objectives: The intention of this paper is to provide ethical guidelines or strategies with regards to decision-making on truth-telling of terminal illness for Chinese nurses. Methods: This paper initially present a case scenario and then critically discuss the ethical issue in association with ethical principles and philosophical theories. Instead of focusing on attitudes toward truth disclosure, it aims to provide strategies regarding this issue for nurses. It highlights and discusses some of the relevant ethical assumptions around the perceived role of nurses in healthcare settings by focusing on nursing ethical virtues, nursing codes of ethics, and philosophical perspectives. And Confucian culture is discussed to explicate that deontology does not consider family-oriented care in China. Conclusion: Treating each family individually to explore the family’s beliefs and values on this issue is essential in healthcare practice and nurses should tailor their own approach to individual needs regarding truth-telling in different situations. Moreover, the Chinese Code of Ethics should be modified to be more specific and applicable. Finally, a narrative ethics approach should be applied and teamwork between nurses, physicians and families should be established to support cancer patients and to ensure their autonomy and hope. Ethical considerations: This paper was approved by the Ethics Committee of The Second Affiliated Hospital of Guangzhou Medical University. The authors have obtained consent to use the case study and it has been anonymised to preserve the patient's confidentiality.

Recent decades have seen an explosion of research into children’s eyewitness capabilities and resulted in legal reform to render the adversarial trial process more child friendly. Many, however, have been left with the feeling that the most intimidating legal process for child complainants—cross-examination—has not changed meaningfully despite its potential to distort children’s evidence. To test this possibility, we compared the cross-examination questioning of Australian child sexual abuse complainants in the 1950s to that used in contemporary cases. We found that the format of cross-examination questions has remained largely consistent over time, with leading questions still making up the bulk of the questions asked. The changes that we did observe, however, are concerning. Cross-examination questions posed to contemporary child complainants were less likely to be open-ended and more likely to be complex, relative to those asked in the 1950s. Crucially, contemporary complainants were asked 3 times as many cross-examination questions as they were 60 years ago. These changes are likely to have detrimental effects on child complainants and their evidence and could reduce the ability of jurors to reach just outcomes in these cases.

This report examines rates of HIV status disclosure and negative responses to disclosure among people living with HIV in Australia. Among 697 people living with HIV, most (>90%) had disclosed their status to friends, sexual partners and health providers. Almost a third had not disclosed to family, and half had not told any work colleagues. Negative responses to disclosure (e.g. blame, rejection) by all groups were associated with increased HIV-related stigma, psychological distress and diminished social support and health satisfaction. These results shed light on rates of disclosure among people living with HIV in Australia and the adverse health impacts of negative responses to disclosure.

Employee silence constitutes a significant threat to organizational success. This article argues that silence is a by-product of a structural Conflict of Interest (COI) between employees and their employers. This argument turns on the claim, also defended here, that employees are in a privileged position vis-à-vis knowledge of their work and that leaders—whether they recognize it or not—are dependent on their employees for reliable information about the work they are doing. Employee voice, therefore, is an organizational necessity. It is also a moral achievement as it involves risking one’s personal interests for the sake of the organization. Leaders must take steps to mitigate COI and encourage employee voice; this article provides several strategies for doing exactly that.

Disclosure of HIV status to family members could improve communication, relationship, and cohesion. We evaluated the impact of a family-centered program designed to increase the readiness/willingness of parents to disclose HIV status to their children. People living with HIV (PLWH) with children ≥8 years were surveyed regarding HIV knowledge, family relationship, attitudes, willingness/readiness to disclose, and they were then invited to participate in group education and family camps. Of 367 PLWH surveyed, 0.8% had disclosed, 14.7% had not yet disclosed but were willing/ready to disclose, 50.4% were willing but not ready, and 33.2% did not wish to disclose. The educational sessions and camps led to significant improvements of HIV knowledge and disclosure techniques, and readiness/willingness to disclose. Given the benefits of group education and family camps in supporting PLWH to improve their communication with their families and disclose their HIV status, these supporting activities should be included in HIV programs.

This community-based observational study of 1,325 women seen for antenatal care examined how women in Pakistan define violence against women (VAW), with an emphasis on domestic violence, what an acceptable response to violence is, reasons for remaining silent, and whether participants are willing to disclose incidents of domestic violence to others. Nearly half of the study participants believed that physical violence was VAW. Verbal abuse, controlling behavior by the husband, conflict with in-laws, overburdening domestic work, and threatening to leave or remarry were also considered VAW. However, only five respondents (0.4%) considered sexual abuse to be VAW. Most women who screened positive for domestic violence responded by remaining silent or verbal fighting back. None sought professional help. Women who decided to remain silent feared that the abuse would escalate or that responding would not help them. Women cited social stigma and concerns about the impact of the violence on children as reasons for not disclosing violent incidents to others or seeking professional help. Women’s lack of autonomy further reduced their ability to take steps against violence. Although societal norms, particularly patriarchal beliefs and women’s subordination to men, likely explain women’s tolerance of abuse, their recognition of physical abuse as violence indicates that they do not necessarily believe it is always justified. Educational interventions to drive changes in the social norms around gender violence along with effective and enforceable legal measures are likely required to ensure women’s safety.

The underreporting of sexual assault is well known to researchers, practitioners, and victims. When victims do report, their complaints are unlikely to end in arrest or prosecution. Existing research on police discretion suggests that the police decision to arrest for sexual assault offenses can be influenced by a variety of legal and extra-legal factors particularly challenges to victim credibility. Although extant literature examines the effects of individual behaviors on police outcomes, less is known about how the accumulation of these behaviors, attributions, and characteristics affects police decision making. Using data collected from the Los Angeles Police Department and Sheriff’s Department, we examine one police decision point—the arrest to fill this gap in the literature. First, we examine the extent to which the effects of potential challenges to victim credibility, based on victim characteristics and behaviors, influence the arrest decision, and next, how these predictors vary across circumstances. Specifically, we examine how factors that challenge victim credibility affect the likelihood of arrest in sexual assault cases where the victim and offender are strangers, acquaintances, and intimate partners.

Background: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as ‘incompetent’ decision makers regarding their own care. Objective: The aim of the study was to deepen the understanding of stroke team members’ reasoning about truth-telling in end-of-life care due to acute stroke. Research design: Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis. Participants and research context: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Findings: The main findings were the team members’ dynamic movement between the categories ‘Truth above all’ and ‘Hide truth to protect’. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. Discussion: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient’s best interest first. Conclusion: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.

Background: Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses’ follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party – the child – have attracted limited attention. Objective: The study explores challenges of confidentiality linked to a third party in nurse–patient relationships in a rural Tanzanian HIV/AIDS context. Study context: The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%. Methods: Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes. Ethical considerations: Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway. Findings and discussion: The material indicates a delicate balance between the nurses’ attempt to secure the HIV-free survival of the babies and the mothers’ desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient’s restricted disclosure came to light during follow-up of the HIV-positive women and the third party – the child who is at risk of HIV infection through mother’s milk. World Health Organization’s substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion.

Purpose: Nondisclosure of terminal prognosis in the context of intercultural interactions can cause moral distress among health care providers guided exclusively by informed consent. However, cultural humility can show that revealing and withholding prognostic information are two equally valid paths to the goal of protecting the patient from harm. Design: Assumptions and history giving rise to the preference for truth telling in the United States(US) are examined. Principles of biomedical ethics are described within the context of US, Chinese, and Latin American cultures. The process of cultural competence in the delivery of health care services is explained and introduces the concept of cultural humility. Implications for Practice: By focusing more on biases and assumptions brought forth from the dominant culture, health care providers may experience less moral distress and convey increased caring in the context of intercultural interactions and nondisclosure of prognosis of a terminal illness.

Objectives This study aimed to explore the challenges parents of children with epilepsy (CWE) experienced when deciding to disclose their child’s epilepsy diagnosis to others. Methods Using a qualitative exploratory design, interviews were conducted with 34 parents (27 mothers and 7 fathers) of 29 CWE (aged 6–16 years). Parents were recruited from a neurology clinic of a specialist children’s hospital and from a national epilepsy association. Interviews were directed by a semi-structured guide informed by a review of the literature. Data were transcribed verbatim, imported into NVivo, coded and thematically analysed. Results Findings revealed five themes representative of the core disclosure challenges parents encountered, many of which promoted concealment and/or selective disclosure, namely: seeking normalcy for the child, the invisibility of epilepsy, negative reactions to disclosure, contending with poor public perceptions of epilepsy and coming to terms with the diagnosis. Discussion This study presents crucial information for healthcare professionals (HCPs) who help families to navigate the disclosure decision-making process. Providing HCPs working with families living with epilepsy with insight into diagnosis disclosure challenges will enable them to recognise the support needs of parents and work collaboratively with families to tackle such difficulties, ultimately improving their psychosocial wellbeing.

Objectives This qualitative study examines how and why adolescents living with visible and invisible chronic illnesses choose to share their condition with individuals within their social environments. Methods A sample of 25 adolescents were recruited from five subspecialty services: Spina bifida, rheumatology, cardiology, cystic fibrosis, and renal transplant/dialysis. Recruits completed a semi-structured interview designed to explore: (1) to whom adolescents disclose their conditions, (2) motivation and conditions under which they disclose, (3) content of disclosure, and (4) barriers to disclosure. Results Family members closely connected to treatment or management are most likely to be primary targets of disclosure. Regardless of social network size, respondents disclosed their illness to few peers. Common reasons for disclosure were perceived trust and shared experience with illness and disability. Reasons for withholding disclosure include perceived fear of rejection, pity, and perceptions of being seen as vulnerable or different. Discussion Disclosure was found to be influenced by (a) the visibility of a condition, (b) the anticipated response from the recipient, (c) practical needs, and (d) a decision that disclosure is justified. These findings inform clinical practice, warrant the need for further study, and insinuate practical solutions to combat the socio-emotional impact of nondisclosure among adolescents.

Background: Cancer patients’ preferences regarding disclosure of prognosis and end-of-life care remain under-reported from low- and middle-income countries where cancer poses an increasing demand on scarce healthcare resources. A better knowledge of these preferences can help in achievement of shared treatment goals. Aim: To survey preferences of adult cancer patients regarding disclosure of prognosis and end-of-life care Design: A multidimensional questionnaire was developed to survey consecutively sampled patients. A fifth of the participants completed a repeat survey 3 months later. Setting/participants: Adult patients at a specialist cancer center in Pakistan. Results: In total, 520 patients were surveyed initially (participation rate 98.6%) and 100 completed the repeat survey. Three in five respondents wanted a healthcare provider to give them detailed information about their prognosis and life expectancy. Those who wanted information withheld were significantly more likely to be female, to have a lower socioeconomic status, or to have lung cancer. Only two in five patients agreed that they wanted to die at home and more than 90% wanted all possible care till end-of-life. Yet, a little over half also agreed that they did not wish to be placed on a ventilator. In rank ordering preferences about end-of-life, respondents ranked “religious wellbeing” as the highest and “avoiding inappropriate prolongation of dying” as the lowest of six options. Conclusion: A majority of adult cancer patients surveyed in this study wanted a truthful disclosure about their disease prognosis and expressed a preference for hospital-based care at end-of-life. Healthcare providers should find ways to tailor prognostic information to patients’ expressed information needs.

Unproctored, web-based assessments supposedly reduce social desirability distortions in self-report questionnaires because of an increased sense of privacy among participants. Three random-effects meta-analyses focusing either on social desirability ( k = 30, total N = 3,746), the Big Five of personality ( k = 66, total N = 2,951), or psychopathology ( k = 96, total N = 16,034) compared social desirability distortions of self-reports across computerized and paper-and-pencil administration modes. Overall, a near-zero effect, Δ = 0.01, was obtained that did not indicate less socially desirable responding in computerized assessments. Moreover, moderator analyses did not identify differential effects for proctored and unproctored procedures. Thus, paper-and-pencil and computerized administrations of self-report scales yield comparable mean scores. Unproctored web-based surveys do not offer an advantage with regard to socially desirable responding in self-report questionnaires.