Adolescents� Need for Healthcare Privacy Could Affect Care

CINCINNATI–Healthcare providers must adapt to the desire of adolescents for privacy in the healthcare setting or risk compromising care, according to a new study.

The Cincinnati Children’s Hospital Medical Center study shows that teens are cautious about revealing sensitive information to providers in fear of being judged. They also are reluctant to talk to unfamiliar or multiple providers.

The job of the healthcare provider is to make it as easy as possible for teens to be forthcoming and to be respectful of their willingness or unwillingness to disclose information, says Maria Britto, MD, an adolescent medicine physician at Cincinnati Children’s and the study’s lead author.

Britto also is a professor of pediatrics at the University of Cincinnati College of Medicine. The study will be published in the online edition of Pediatrics Nov. 22.

"If the information isn't urgent, such as a routine health visit, providers may be better off waiting to ask sensitive questions until they know the teen better and can get better information once they’ve established trust,” says Britto.

"If they do need information because it will impact diagnosis or treatment, then there are many things they can attend to that may make the adolescent more comfortable disclosing information.”

Changes in communication and office practice, such as asking permission to discuss sensitive topics, explaining the importance of asking personal questions and increasing privacy during physical exams may improve the experience for teens, says Britto.

"Providers should discuss with adolescents the availability of their medical information to other medical professionals to improve quality of care or operations,” says Britto. "In this way, the patient can understand and feel more comfortable with the process and be less likely to see it as a privacy violation.”

To determine adolescents’ preferences for privacy, Britto conducted 12 focus groups for 54 adolescents. Keeping health care information private was the most important privacy issue to adolescents, but there are also psychological, social and physical components to privacy that must be addressed to improve the care of adolescent patients, says Britto.

She found that younger adolescents tended to want more parent involvement than older teens. Some older adolescents, however, said they might avoid a healthcare visit entirely to prevent providers from sharing information with parents.

Other findings on psychological, social and physical privacy include:

• Healthy adolescents of all ages said they would avoid discussing sensitive topics with providers if they thought the provider would think less of them or "jump to conclusions.”
• Younger teens said they avoided personal discussions with providers they didn’t know or like, or believed that the provider did not need to know the information.
• Only younger adolescents expressed concerns about violations of physical privacy.

Britto found that adolescents with chronic illness better understood and accepted the importance of information sharing among health care professionals. Healthy adolescents thought such sharing was inappropriate

and unnecessary, she says.