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September 24, 1997

Influence of Physician Confidentiality Assurances on Adolescents' Willingness to Disclose Information and Seek Future Health Care: A Randomized Controlled Trial

Author Affiliations

From the Division of Adolescent Medicine, Department of Pediatrics, University of California at San Francisco. Dr Ford is now with the Division of Community Pediatrics, Adolescent Medicine Section, Department of Pediatrics, University of North Carolina at Chapel Hill.

JAMA. 1997;278(12):1029-1034. doi:10.1001/jama.1997.03550120089044

Context.  —Adolescents' concerns about privacy in clinical settings decrease their willingness to seek health care for sensitive problems and may inhibit their communication with physicians.

Objective.  —To investigate the influence of physicians' assurances of confidentiality on adolescents' willingness to disclose information and seek future health care.

Design.  —Randomized controlled trial.

Setting.  —Three suburban public high schools in California.

Participants.  —The 562 participating adolescents represented 92% of students in mandatory classes.

Intervention.  —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.

Main Outcome Measures.  —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.

Results.  —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) (β=.10, P=.02) and increased the number willing to seek future health care from 53% (93/175) to 67% (259/386) (β=.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) (β=.14, P=.001).

Conclusions.  —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.