By DAVID WILLIAMSON
UNC-CH News Services
(Embargoed) CHAPEL HILL -- Promising and maintaining confidentiality would allow U.S. doctors and other health-care providers to gain more complete information from teen-age patients and treat and advise them more successfully, a new study shows.
The study, appearing in the Sept. 24 issue of the Journal of the American Medical Association, found teens are increasingly willing to disclose sensitive information when doctors specifically say they will not tell parents or others what was said.
Adolescents assured their words will not be repeated are more likely than other teens to talk about smoking, drinking and drug use, sexual behavior and their mental state. They also are more likely to return for follow-up doctor visits.
"These findings are important because some adolescents don't go for health care or talk openly with doctors because they are afraid their parents will find out things they don't want parents to know," said Dr. Carol A. Ford, assistant professor of pediatrics and medicine at the University of North Carolina at Chapel Hill School of Medicine. "For example, in this study 96 out of 562 teen-agers, or 17 percent, reported they had not gone for health care at some time in the past because of concerns their parents would find out. Of teen-agers who had seen a doctor and had been asked about sensitive health topics, many reported they were not honest when answering questions.
"Although physicians routinely encourage teen-agers to openly communicate with their parents, it's often useful for teens to be able to talk with responsible, trusted adults such as physicians outside the family. Our work clearly demonstrates that teens really hear what doctors say about confidentiality and that being assured of confidentiality increases the chance that teens will go see and talk with physicians about routine sensitive health concerns."
Besides Ford, the study principal investigator, report authors are Drs. Susan G. Millstein, Bonnie L. Halpern-Felsher and Charles E. Irwin Jr., all of the University of California at San Francisco faculty.
The new study involved 562 students at three California high schools who were randomly assigned to three groups. Students listened to audio tapes depicting visits to a doctor who assured complete confidentiality, confidentiality except in situations with suspected suicide risk or abuse or did not mention confidentiality at all.
They then answered written questionnaires designed to get their reactions to what they heard, and researchers analyzed the results.
"Assurances of confidentiality boosted the number of adolescents' willing to disclose sensitive information about sexuality, substance use and mental health from 39 percent to about 47 percent," Ford said. "They also increased the number willing to seek future health care from 53 percent to 67 percent."
When comparing complete and partial confidentiality assurance groups, assurances of complete confidentiality boosted the number of adolescents willing to return for a future visit from 62 percent to 72 percent.
Despite the apparent advantage of promising adolescents complete confidentiality, physicians cannot make such a promise in clinical situations, she said.
"Further investigation is needed to identify a statement that explains the legal and ethical limitations of confidentiality without decreasing adolescents' likelihood of seeking future care for routine and non-reportable, sensitive health concerns," Ford said. "Legal and ethical limitations to confidentiality chiefly arise when teens say they are planning to kill themselves, kill others or are being physically or sexually abused."
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Note: Ford can be reached at (919) 966-2504 (w).
Contact: David Williamson
Journal
JAMA