Maria G. Checton

Assessing Health Diagnosis Disclosure Decisions in Relationships: Testing the Disclosure Decision-Making Model

Illness affects millions of Americans each year, and the disclosure of health conditions can facilitate access to social support, in addition to other physical and physiological benefits. This article tests the Disclosure Decision-Making Model (DD-MM; Greene, 2009) to predict factors that influence the likelihood of disclosing (and past disclosure of) nonvisible physical or mental health-related information. One hundred eighty-seven (n = 187) people were recruited for a study to report on both disclosing and not disclosing a nonvisible health condition. Measured variables included information assessment, relational quality, anticipated reactions (support, relational consequences), confidence in response, disclosure efficacy, and disclosure (likelihood of disclosure and depth of disclosure). Structural equation modeling results supported many of the proposed hypotheses, with a great deal of similarity across models. Specifically, assessing information predicted efficacy, and to some extent relational outcomes. Closeness was related to response overall and to efficacy in one model. Response predicted outcome overall and likelihood of disclosure in one model. Finally, efficacy predicted likelihood of disclosure and depth of disclosure. The article discusses the implications of the findings for understanding information, relationship assessments, and efficacy in disclosing health diagnoses.

Beyond Initial Disclosure: The Role of Prognosis and Symptom Uncertainty in Patterns of Disclosure in Relationships

This study is framed in Greenes (2009) health disclosure decision-making model (DD-MM) and explores the role of prognosis and symptom uncertainty in patterns of disclosure in a close relationship. Toward this end, an uncertainty and disclosure model is hypothesized in which prognosis and symptom uncertainty and relational quality are expected to predict perceived partner support, communication efficacy, and the depth, breadth, and frequency of disclosure to a partner about a chronic health condition. Patients with diagnosed heart-related conditions visiting a private medical office were recruited to complete anonymous surveys. Results indicated that (1) the key mechanisms identified in the DD-MM are associated with the depth, breadth, and frequency of disclosure to a partner about a health condition, and (2) uncertainty plays a prominent role in peoples communication with their partner about the heart-related condition. The findings and implications of the study are discussed.

Patients' and Partners' Perspectives of Chronic Illness and Its Management

This study is framed in theories of illness uncertainty (Babrow, A. S., 2007, Problematic integration theory. In B. B. Whaley & W. Samter (Eds.), Explaining communication: Contemporary theories and exemplars (pp. 181-200). Mahwah, NJ: Erlbaum; Babrow & Matthias, 2009; Brashers, D. E., 2007, A theory of communication and uncertainty management. In B. B. Whaley & W. Samter (Eds.), Explaining communication: Contemporary theories and exemplars (pp. 201-218). Mahwah, NJ: Erlbaum; Hogan, T. P., & Brashers, D. E. (2009). The theory of communication and uncertainty management: Implications for the wider realm of information behavior. In T. D. Afifi & W. A. Afifi (Eds.), Uncertainty and information regulation in interpersonal contexts: Theories and applications, (pp. 45-66). New York, NY: Routledge; Mishel, M. H. (1999). Uncertainty in chronic illness. Annual Review of Nursing Research, 17, 269-294; Mishel, M. H., & Clayton, M. F., 2003, Theories of uncertainty. In M. J. Smith & P. R. Liehr (Eds.), Middle range theory for nursing (pp. 25-48). New York, NY: Springer) and health information management (Afifi, W. A., & Weiner, J. L., 2004, Toward a theory of motivated information management. Communication Theory, 14, 167-190. doi:10.1111/j.1468-2885.2004.tb00310.x; Greene, K., 2009, An integrated model of health disclosure decision-making. In T. D. Afifi & W. A. Afifi (Eds.), Uncertainty and information regulation in interpersonal contexts: Theories and applications (pp. 226-253). New York, NY: Routledge) and examines how couples experience uncertainty and interference related to one partners chronic health condition. Specifically, a model is hypothesized in which illness uncertainty (i.e., stigma, prognosis, and symptom) and illness interference predict communication efficacy and health condition management. Participants include 308 dyads in which one partner has a chronic health condition. Data were analyzed using structural equation modeling. Results indicate that there are significant differences in (a) how patients and partners experience illness uncertainty and illness interference and (b) how appraisals of illness uncertainty and illness interference influence communication efficacy and health condition management. We discuss the findings and implications of the study.

“You can't tell anyone but …”: Exploring the Use of Privacy Rules and Revealing Behaviors

This three-part study examines how privacy rules function to protect shared information from further revelation. Communication Privacy Management served as a theoretical framework to investigate issues related to boundary management. In the pilot study, college students (N = 409) described privacy rules and their use, and participants reported not further revealing the information when privacy rules were expressed by disclosers. In Study 1, participants (N = 167) reported on disclosing health-related information, and participants did not anticipate that recipients would further reveal especially when they used a privacy rule. In Study 2, dyads (dyad N = 257) reported on shared disclosure experiences, including both anticipated and actual boundary management. Study 2 findings include that privacy rules have limited effectiveness. The article discusses implications of privacy rule use when sharing private information.

Decision Making in Cancer-Related Topic Avoidance

In this article, the authors use the Disclose Decision-Making Model to explore cancer-related topic avoidance among cancer patients and their partners. Participants include 95 dyads in which 1 partner had been diagnosed and/or treated for cancer. Variables of interest include death-, future-, sexuality-, and burden-related topic avoidance and dimensions of the Disclosure Decision-Making Model including information assessment, receiver assessment, relational quality, and discloser efficacy. Data were analyzed using linear regressions. Findings suggest that lack of reciprocity and efficacy are predictors of topic avoidance. The authors discuss implications of findings and suggests direction for future research.

A dyadic approach: applying a developmental-conceptual model to couples coping with chronic illness.

The purpose of the present study was to apply Berg and Upchurch’s developmental-conceptual model toward a better understanding of how couples cope with chronic illness. Specifically, a model was hypothesized in which proximal factors (relational quality), dyadic appraisal (illness interference), and dyadic coping (partner support) influence adjustment (health condition management). The study was cross-sectional and included 308 dyads in which one partner has a chronic health condition. The actor partner interdependence model shows how congruence and noncongruence in relational quality, dyadic appraisal, and dyadic coping influence dyadic adjustment.

I Tell My Partner Everything . . . (or Not): Patients' Perceptions of Sharing Heart-Related Information With Their Partner

This study is grounded in theories of information management. Patients with a diagnosed heart-related condition (N = 253) completed a survey regarding their perceptions of sharing/not sharing information with a partner about their health condition. Data were analyzed using descriptive and inferential statistics. Results indicated that although most patients reported sharing “everything” with their partner, others reported not sharing certain topics such as health issues and physical symptoms/ailments. In addition, patients who reported sharing everything with a partner reported significantly greater communication efficacy, and breadth, depth, and frequency of communication about a heart-related condition compared with those who reported not sharing certain topics. Finally, as hypothesized, there were no significant group differences in terms of sharing specific physical and psychological health information. We discuss the findings and implications of the study for nursing practice.

Elderly patients’ heart-related conditions: Disclosing health information differs by target

Americans are living longer, and many are managing at least one chronic illness. Having people with whom to disclose health information is a salient component of managing a chronic health condition, such as heart disease. The purpose of this study is to explore differences in elderly patients’ health disclosures by target (i.e. disclosing to a partner vs. another person). Elderly patients (>age 60) with a diagnosed heart-related condition (n = 273) completed a survey regarding sharing information about their health condition. Results indicated significant differences between the two groups in perceived support; breadth, depth, and frequency of disclosures; and disclosure of psychological/emotional symptoms, physical symptoms, and talk about heart-healthy behaviors. No significant differences were found between the two groups for relationship quality and efficacy. Patients who reported sharing information with a partner reported significantly more health information disclosures compared to patients who reported sharing information with another person.

College students' use of compliance-gaining strategies to obtain prescription stimulant medications for illicit use

Objective: To examine college students’ illicit use of prescription stimulant medications and compliance-gaining strategies that they would use to obtain a stimulant medication. Design: A questionnaire-based study. Setting: Seven hundred and twenty undergraduate college students at a large, northeastern university in the United States were surveyed. Method: The study received approval from the university’s Institutional Review Board (IRB). Students completed anonymous questionnaires outside of class time. Results: Respondents were more likely to use rationality and promise strategies to gain others’ compliance. No differences in strategy selection for close friends and acquaintances were reported. Illicit prescription stimulant users scored higher in sensation seeking than those who reported no prior illicit stimulant use. Conclusions: A compliance-gaining perspective provided a better understanding of the strategies college students are likely to use to obtain prescription stimulants from those with a legitimate prescription.

Planning a Stigmatized Nonvisible Illness Disclosure: Applying the Disclosure Decision-Making Model

ABSTRACT This study applied the disclosure decision-making model (DD-MM) to explore how individuals plan to disclose nonvisible illness (Study 1), compared to planning to disclose personal information (Study 2). Study 1 showed that perceived stigma from the illness negatively predicted disclosure efficacy; closeness predicted anticipated response (i.e., provision of support) although it did not influence disclosure efficacy; disclosure efficacy led to reduced planning, with planning leading to scheduling. Study 2 demonstrated that when information was considered to be intimate, it negatively influenced disclosure efficacy. Unlike the model with stigma (Study 1), closeness positively predicted both anticipated response and disclosure efficacy. The rest of the hypothesized relationships showed a similar pattern to Study 1: disclosure efficacy reduced planning, which then positively influenced scheduling. Implications of understanding stages of planning for stigmatized information are discussed.