Confidentiality oxford Flashcards

1
Q

Define confidentiality

A
  • establishes and maintains confidence and trust in the relationship between patient and provider.
  • special attention to use of any and all information disclosed by or obtained from patients during their care experience
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2
Q

Basics of respecting confidentiality

A
  1. Establish and follow organizational practices that effectively respect confidentiality
    1. policies re: disclosure, record keeping, email/fax, compliance with law
  2. Be clear with patients and families about practices of confidentiality in practice
  3. Immediately inform patients when breaches have occurred. Take action to mitigate damage
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3
Q

Justifying a duty to maintain confidentiality

A
  • Respect for personhood
  • Optimizing clinical outcomes
  • Avoiding preventable harm
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4
Q

Confidentiality Cases :

Mr Q is a 67 M with breast cancer, progressive disease. Adamant about making decisions independently; does not want to disclose dx to family. Emasculating, humiliating. Family distressed by lack of disclosure. Hospice staff distressed by family distress because supposed to be family-centred.

A
  • Respecting personhood
    • patient has been clear in his desire to not disclose
    • respecting this respects his personhood
  • Maximizing clinical outcomes
    • respecting confidentiality builds trust, better sx management
  • Preventing harm
    • team member could work with patient to explore belief
    • educate him about prevalence, etc
    • offer to work with family to help them understand
    • work with Mr Q to do full family health questionnaire
    • If family members at genetic risk, could present to Mr Q and support him to disclose to family himself.

This scenario is best supported by respecting patient’s confidentiality

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5
Q

Confidentiality Case 2:

Mrs. S 86 Caucasian F with end stage CHF. Declining in hospital, daughter very attentive in care. Patient asks nurse to witness a change in her will to leave less to her son. Nurse distraught because she will be betraying daughter and colluding behind her back.

A
  • Respecting personhood
    • Mrs S has the right to discretion about her will.
    • Role of witness is simply to attest that she has decision making capacity and is changing it voluntarily
    • Nusre can express her views about disclosing to daughter.
    • Needs to agree to signing and terms of it (non disclosure)
  • Maximizing beneficial clinical outcomes
    • maintaining confidentiality is likely to build trust and maximize outcomes
  • Preventing harm
    • relationship with nurse is very brief (1 week)
    • nurse should assume that Mrs S knows best and honour confidentiality to prevent the perceived harm from occurring (anxiety and distress)
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6
Q

Confidentiality Case 3:

Mr. L is 62 M with ALS. Discloses to home care nurse that vet gave him pentobarbital for end of life. He plans to take it this weekend.

A
  • Respecting personhood.
    • is the patient’s desire is rational and voluntary?
    • distinguishes suicidal ideation from desire for hastened death?
    • does the patient have decision making capacity?
    • If suicidal and not rational - may require intervention that breaches confidentiality.
    • can further and deeply explore with patient.
  • Maximize beneficial clinical outcomes
    • rational and voluntary ?
    • patient has decided that death is more beneficial outcome for him than continuing to live with declining function
    • unknown if he has enough medication for peaceful death.
  • Preventing harm
    • harm
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