Confidentiality oxford

Question 1

Define confidentiality

Answer 1

• 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

Question 2

Basics of respecting confidentiality

Answer 2

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

Question 3

Justifying a duty to maintain confidentiality

Answer 3

• Respect for personhood
• Optimizing clinical outcomes
• Avoiding preventable harm

Question 4

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.

Answer 4

• 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

Question 5

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.

Answer 5

• 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)

Question 6

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.

Answer 6

• 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