Confidentiality oxford Flashcards
Define confidentiality
- 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
Basics of respecting confidentiality
- Establish and follow organizational practices that effectively respect confidentiality
- policies re: disclosure, record keeping, email/fax, compliance with law
- Be clear with patients and families about practices of confidentiality in practice
- Immediately inform patients when breaches have occurred. Take action to mitigate damage
Justifying a duty to maintain confidentiality
- Respect for personhood
- Optimizing clinical outcomes
- Avoiding preventable harm
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.
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Respecting personhood
- patient has been clear in his desire to not disclose
- respecting this respects his personhood
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Maximizing clinical outcomes
- respecting confidentiality builds trust, better sx management
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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
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.
- 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)
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.
- 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