青少年隐私保密：医疗服务提供者的理解与实践
Adolescent confidentiality: Understanding and practices of health care providers.
作者信息
Wadman Ruth, Thul Deborah, Elliott April S, Kennedy Andrea Pritchard, Mitchell Ian, Pinzon Jorge L
机构信息
Alberta Children's Hospital;
Alberta Children's Hospital; ; University of Calgary;
出版信息
Paediatr Child Health. 2014 Feb;19(2):e11-4. doi: 10.1093/pch/19.2.e011.
BACKGROUND
Adolescent confidentiality may present practice challenges for health care providers related to family, medical, ethical, legal, social and bureaucratic processes. It is unclear how health care providers understand and practice confidentiality with adolescents in Canada.
OBJECTIVE
To investigate the knowledge and practice of health care providers at Alberta Children's Hospital (Calgary, Alberta), and to inform practice about the adolescent's right to confidentiality.
METHODS
The present study was a voluntary, anonymous online survey. Invitations to participate were sent through the paediatric facility's electronic mailing list to all currently employed health care providers who potentially engaged in caregiving interactions with adolescents. The survey consisted of 15 closed items and seven open comment items. Closed items were analyzed using descriptive statistics and open comments were analyzed using manifest thematic coding.
RESULTS
A total of 389 responses were received, representing health care providers in many disciplines. A variety of practices related to adolescent confidentiality and widespread misunderstanding of this issue were apparent. Respondents' comments revealed individual and team knowledge gaps regarding adolescent and parent/guardian rights, and the difference between the constructs of consent to treatment and the provision of confidential health care for adolescents.
CONCLUSIONS
While health care providers regard confidentiality as paramount, the present survey revealed a wide variation in understanding and practices regarding confidential care for adolescents. This was revealed in both the qualitative and quantitative data. The authors' recommended strategies to improve the understanding and practice of adolescent confidentiality include: encouraging individuals' examination of beliefs; postsecondary instruction; knowledge-translation strategies within programs; and institution-directed guidelines and policy.
背景
青少年隐私保密问题可能给医疗服务提供者带来诸多实践挑战，涉及家庭、医疗、伦理、法律、社会及行政流程等方面。目前尚不清楚加拿大的医疗服务提供者如何理解并践行对青少年的隐私保密原则。
目的
调查艾伯塔儿童医院（位于艾伯塔省卡尔加里市）医疗服务提供者关于青少年隐私保密的知识与实践情况，为青少年隐私保密权的实践提供参考。
方法
本研究采用自愿、匿名的在线调查方式。通过儿科机构的电子邮件列表，向所有可能与青少年有护理互动的在职医疗服务提供者发送参与邀请。调查问卷包括15个封闭式问题和7个开放式评论问题。封闭式问题采用描述性统计方法进行分析，开放式评论采用显性主题编码进行分析。
结果
共收到389份回复，涵盖多个学科的医疗服务提供者。与青少年隐私保密相关的多种实践情况以及对此问题的普遍误解较为明显。受访者的评论揭示了在青少年及其父母/监护人权利方面以及治疗同意和为青少年提供保密医疗服务这两个概念之间的差异方面存在个人和团队知识差距。
结论
尽管医疗服务提供者将隐私保密视为首要原则，但本次调查显示，在对青少年保密医疗服务的理解和实践方面存在很大差异。这在定性和定量数据中均有体现。作者推荐的改善对青少年隐私保密理解和实践的策略包括：鼓励个人审视自身观念；开展高等教育教学；在项目中采用知识转化策略；以及制定机构指导方针和政策。
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