Ford C A, Millstein S G, Halpern-Felsher B L, Irwin C E
Department of Pediatrics, University of California at San Francisco, USA.
JAMA. 1997 Sep 24;278(12):1029-34.
Adolescents' concerns about privacy in clinical settings decrease their willingness to seek health care for sensitive problems and may inhibit their communication with physicians.
To investigate the influence of physicians' assurances of confidentiality on adolescents' willingness to disclose information and seek future health care.
Randomized controlled trial.
Three suburban public high schools in California.
The 562 participating adolescents represented 92% of students in mandatory classes.
After random assignment to 1 of 3 groups, the adolescents listened to a standardized audiotape depiction of an office visit during which they heard a physician who assured unconditional confidentiality, a physician who assured conditional confidentiality, or a physician who did not mention confidentiality.
Adolescents' willingness to disclose general information, willingness to disclose information about sensitive topics, intended honesty, and likelihood of return visits to the physician depicted in the scenario were assessed by anonymous written questionnaire.
Assurances of confidentiality increased the number of adolescents willing to disclose sensitive information about sexuality, substance use, and mental health from 39% (68/175) to 46.5% (178/383) (beta=.10, P=.02) and increased the number willing to seek future health care from 53% (93/175) to 67% (259/386) (beta=.17, P<.001). When comparing the unconditional with the conditional groups, assurances of unconditional confidentiality increased the number of adolescents willing to return for a future visit by 10 percentage points, from 62% (122/196) to 72% (137/190) (beta=.14, P=.001).
Adolescents are more willing to communicate with and seek health care from physicians who assure confidentiality. Further investigation is needed to identify a confidentiality assurance statement that explains the legal and ethical limitations of confidentiality without decreasing adolescents' likelihood of seeking future health care for routine and nonreportable sensitive health concerns.
青少年在临床环境中对隐私的担忧降低了他们因敏感问题寻求医疗保健的意愿，并可能抑制他们与医生的交流。
调查医生对保密的保证对青少年披露信息和寻求未来医疗保健意愿的影响。
随机对照试验。
加利福尼亚州的三所郊区公立高中。
562名参与的青少年占必修课学生的92%。
在随机分配到3组中的1组后，青少年听一段标准化的办公室就诊录音描述，在录音中他们听到一位保证无条件保密的医生、一位保证有条件保密的医生或一位未提及保密的医生。
通过匿名书面问卷评估青少年披露一般信息的意愿、披露敏感话题信息的意愿、预期的诚实度以及回访情景中所描述医生的可能性。
保密保证使愿意披露有关性、物质使用和心理健康等敏感信息的青少年人数从39%（68/175）增加到46.5%（178/383）（β=0.10，P=0.02），并使愿意寻求未来医疗保健的人数从53%（93/175）增加到67%（259/386）（β=0.17，P<0.001）。在比较无条件保密组和有条件保密组时，无条件保密保证使愿意回访的青少年人数增加了10个百分点，从62%（122/196）增加到72%（137/190）（β=0.14，P=0.001）。
青少年更愿意与保证保密的医生交流并寻求医疗保健。需要进一步调查以确定一份保密保证声明，该声明能解释保密的法律和道德限制，同时又不降低青少年因常规和不可报告的敏感健康问题寻求未来医疗保健的可能性。
