Confidentiality and adolescents use of providers for health information and for pelvic examinations. CMA Code of Ethics and Professionalism: https://www.cma.ca/En/Pages/code-of-ethics.asp (Accessed June 14, 2022). Two provinces diverge from the mature minor doctrine at the present time. Our initial focus will be with one multidisciplinary group to refine techniques before broadening our approach with other groups, specific professions and new recruits. 2020 Oct;136(4):e70-e80. Juveniles in residential placement: 19972008 (Vol. A home for paediatricians. Le sondage se composait de 15 questions fermes et de sept questions ouvertes. The Society for Adolescent Health and Medicine (SAHM) and the American Academy of Pediatrics (AAP) encourage adolescents to discuss health issues with their parents while also supporting their right to privacy [5] [26]. A fast-evolving issue related to the provision of confidential care for adolescents is the emergence and proliferation of health information technologies. 2017; 46:899-890. Curr Opin Pediatr. Guttmacher Institute, 2017 ). It is not intended to substitute for the independent professional judgment of the treating clinician. Federal government websites often end in .gov or .mil. Should a physician feel uncomfortable about being alone with a patient or reviewing certain sensitive topics, it is appropriate to consider a chaperoned discussion with another HCP present [23]. Access to private and confidential health care among secondary school students in New Zealand. The impact of parental consent on the HIV testing of minors. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Patient- and family-centered care and the pediatricians role. Justified paternalism in adolescent health care. Ginsburg KR, Slap GB, Cnaan A, Forke CM, Balsley CM, Rouselle DM. The concepts of informed consent and confidentiality are complex when the patient is an adolescent. American College of Obstetricians and Gynecologists. (2004). Curr Opin Pediatr 2009;21(4):450-56. By ensuring appropriate quantity and quality of confidential care for adolescents, clinicians are better equipped to elicit a comprehensive history and physical examination, while empowering the adolescent involved to develop agency, autonomy, trust, and responsibility for their own health care decision-making and management. Nurses should ensure adolescents' rights to confidential health care services. Clipboard, Search History, and several other advanced features are temporarily unavailable. Foregone health care among adolescents. Holder, A. Government of Canada. Pediatrics, 130(5), 987990. Over the past few decades, the medical literature has extensively documented that effective care of adolescents requires that the interaction be confidential (4,5). The present voluntary, anonymous online survey was available for data collection over 14 days in March 2012 at the Alberta Childrens Hospital in Calgary (Alberta). Government of Canada. 1-4. Weinstein RS, Krupinski EA, Doarn CR. PubMed Central Meaningful use of a confidential adolescent patient portal. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings [Practice Guideline]. Teaching on confidentiality should extend to all clinicians and front-line staff. While confidentiality and consent are closely related, the two are different constructs and must be understood apart from one another for adolescents to have access to a confidential health care setting that encourages the disclosure of important health information. In the literature, there has been a great deal of discussion about the minors right to consent to treatment. Confidentiality protections encourage adolescents to seek care and openly discuss issues related to sexuality, substance use, and mental health concernssometimes without parental consent or notificationallowing clinicians to fulfill their role in improving adolescent health. doi:10.1016/j.amepre.2012.09.044. Arch Pediatr Adolesc Med 2000;154(9):885-92. Adolescence, AAP Committee on Adolescence. McKee MD, O'Sullivan LF, Weber CM. Oakland, CA: National Center for Youth Law. Confidential care for adolescents is important because it encourages access to care and increases discussions about sensitive topics and behaviors that may substantially affect their health and well-being. American Journal of Public Health, 97(8), 13381341. Adolescents interpretations of conditional confidentiality assurances. Gans, J. Fine LC, Mollen CJ. The .gov means its official. Facilitators and barriers to providing confidential care for adolescents, by clinical setting, Long-term, continuous relationship with a primary care provider, Flexible clinical environment (i.e., designing waiting rooms to maximize privacy or creating and providing pertinent reading material), Continuity of care from a young age allows for early, anticipatory discussions with parents around the need for one-on-one time for the adolescent and HCP, Long-term relationship between parents and the adolescents primary care provider may cast doubt on privacy protections, Long periods in a waiting room can increase feelings of self-consciousness and vulnerability, and may expose them to encounters with peers, Establish an adolescent-friendly environment (i.e., flexible hours, targeted reading material and artwork), Post prominent reminders respecting need for private, confidential medical care, Establish a multidisciplinary health care team to integrate multiple services in one location and maintain a single medical record, High patient volumes allow for broad access to adolescents from different backgrounds, Adolescents with higher levels of risk behaviours are more likely to use an ED as their primary source of care and flag positive when screened, Time constraints, long wait times, and lack of private spaces can lead to missed screening opportunities, Triaging is often conducted in the presence of a parent or caregiver, Protocols to ensure routine screening for risk behaviours in a private setting at time of triage, Tools for promptly screening risky behaviours (i.e., ASQ-S, CRAFT, HEADS-ED), Patients typically spend several days on an inpatient unit, allowing time for in-depth screening, Adolescents with chronic health conditions may not access primary care providers when hospitalized, making tertiary care physicians an alternate form of screening, Family-centred rounds are part of standard care, but discussions and decision-making at bedside are not private, Certain hospital settings do not offer single patient rooms, further limiting private bedside discussions, Large number of team members on clinical teaching units, Elicit and work to adolescent preferences regarding scheduling confidential discussions outside of rounds and including a parent or caregiver, Schedule follow-up discussions with a smaller, more personalized team, ASQ-S:AskSuicide-ScreeningQuestionnaire, CRAFFT:Car,Relax,Alone,Forget,Friends,Trouble, HEADS-ED:Home,Education/Employment,Activities/peers,Drugs/alcohol,Suicidality, Emotions/behaviours/thought disturbance,Discharge or current resources. Please enable it to take advantage of the complete set of features! This site needs JavaScript to work properly. The laws governing consent and confidentiality in adolescent health care vary from country to country . While the present study was performed at the Alberta Childrens Hospital in Calgary, Alberta, we speculate that there may be similar practices in other settings, in Canada as well as in other countries. Forgone health care among U.S. adolescents: Association between risk characteristics and confidentiality concerns. These exceptions are based on a minor's statusor the type of service requested. Effects of reporting and enforcement on access to care for adolescents. HCPs may also be required to disclose confidential patient information due to a court order. Some clinicians believe that to offer adolescents confidential health care, they must assess and document that person as a mature minor in the health record. On ne sait pas comment les dispensateurs de soins comprennent et exercent la confidentialit auprs des adolescents au Canada. However, several barriers to privacy protection exist when telemedicine is compared with in-person visits. Hagan, J., Shaw, J., & Duncan, P. (2008). Clearinghouse KT. Fifty per cent of survey respondents did not know whether there was an age in Alberta when adolescents were entitled to receive confidential health care, and an additional 32% erroneously believed that there was. There were 389 respondents from a potential sample of approximately 1800 employees. Ross AM, White E, Powell D, Nelson S, Horowitz L, Wharff E. To ask or not to ask? CrossRef The provision includes reporting certain communicable diseases to public health, for example. Abstract Confidential care for adolescents is important because it encourages access to care and increases discussions about sensitive topics and behaviors that may substantially affect their health and well-being. Archives of Pediatrics and Adolescent Medicine, 154(9), 885892. American Journal of Preventive Medicine, 44(1 Suppl 2), S119S124. PMC Studies suggest that parent and caregiver views on adolescent confidentiality are mixed, with physicians citing fear of parental resistance as a potential barrier to providing confidential care [24]. US Department of Justice, Office of Juvenile Justice and Delinquency Prevention. All rights reserved. For permission to reprint or reproduce multiple copies, please see our copyright policy. Staff may have been on more than one electronic mailing list, staff may not have checked their e-mail during the time the survey was available and it was not feasible to determining how many of the 1800 staff receiving the survey had the potential to engage in caregiving interactions with adolescents. Sickmund, M. (2010, February). (2013). should be aware of federal and state laws that affect confidentiality. In 2023 and beyond, the protection of personal health information is more critical than ever. If its not absolutely confidential, will information be disclosed? ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Any potential conflicts have been considered and managed in accordance with ACOGs Conflict of Interest Disclosure Policy. 2020 Apr;135(4):e171-e177. This variable understanding is important to note because it appears that all health care providers require some level of further learning and practice support to uphold adolescent confidentiality. Consent and confidentiality for adolescents in health care are too often neglected topics. Variations, taking into account individual circumstances, may be appropriate. 599: Committee on Adoscent Health Care: Adolescent confidentiality and electronic health records. In telemedicine visits, others may be present in-room but out of view, or sessions may be recorded without a patients knowledge or consent. CDC HIV/AIDS fact sheet: HIV/AIDS among youth. Coughlin KW; CPS Bioethics Committee. A total of 389 responses were received, representing health care providers in many disciplines. Visit our ABOG MOC II collection. This Committee Opinion was developed by the American College of Obstetricians and Gynecologists Committee on Adolescent Health Care in collaboration with committee member Kimberly Hoover, MD and liaison member Stephanie Crewe, MD, MHS. Confidentiality and adolescents use of providers for health information and for pelvic exams. Obstet Gynecol. This could include posted documents describing patient rights and making sure families and clinical staff are familiar with and respect these rules. Confidentiality and adolescents willingness to consent to STD testing. Confidentiality is defined as an agreement between the patient and provider whereby information discussed during or after the encounter will not be shared with other parties without the explicit permission of the patient (13). Juvenile Arrests 2008. 1 Multiple studies have found associations between confidentiality practices and receipt of recommended services. Teare, C., & English, A. Any updates to this document can be found on acog.org or by calling the ACOG Resource Center. Blythe, M. J., & Del Beccaro, M. A. Adolescent patients cite confidentiality as one of the key determinants of their use of health care. Most EHR systems have not been designed to provide item-specific control over parental access and release of adolescent health care information. Ford CA, Millstein SG, Halpern-Felsher BL, Irwin CE. Correspondence to In May 2020, the federal Office of National Coordinator for Health Information Technology (ONC) issued a Final Rule implementing key provisions of the 21st Century Cures Act, the ONC Rule. The need for confidential care in all health-related encounters with adolescents has been endorsed by numerous international and national societies [4] [7]. However, there is often misunderstanding and confusion . Full and truthful disclosure by individuals is essential to ensuring appropriate diagnostic testing and therapeutic management. B., Eaton, D. K., Voetsch, A. C., Wiegand, R. E., Miller, K. S., & Doshi, S. R. (2012). JAMA, 288(6), 710714. Reddy, D. M., Fleming, R., & Swain, C. (2002). Federal government websites often end in .gov or .mil. The importance of providing confidential care for adolescents cannot be overstated. Preventative health screening may be best addressed at routine health visits, but it is essential that HCPs create other opportunities to address confidential issues in various practice settings. doi: 10.1542/peds.2022 . doi: 10.1097/AOG.0000000000002945. Moreover, without confidential care, adolescents may decline routine services, such as sexually transmitted infection (STI) testing, or not engage in follow-up care [11]. Some potential respondents may have had a different understanding and interpretation of self-selecting and, with surveys based on self-reporting, there is always the possibility for discrepancy between what is reported and reality. English, A., Ford, C. A., & Santelli, J. S. (2009). Family planning clinic clients: Their usual health care providers, insurance status, and implications for managed care. Klein DA, Paradise SL, Landis CA. There should be private conversation time between the health care provider and adolescent patient. Scan this QR code with your smartphone to view the full-text version of this Committee Opinion. Chicago: American Medical Association. Therefore, just as with right to confidentiality, the capacity of adolescent patients to consent to a proposed treatment varies with age and circumstances and must be determined on a case-by-case basis. Coding frame categories matched the research questions regarding understanding and practice with open categories for further analysis of emerging themes. This combined approach might involve discussion with adolescents about how they perceive a specific disclosure to parents, helping them to weigh the potential advantages of more open communication, and offering to facilitate communication with parents in ways that help the patient. Minor Consent : Based on Status A minor can consent to health care services without a parent or guardian if
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confidentiality in adolescent health care
