TY - JOUR
T1 - Patients with severe mental illness and the ethical challenges related to confidentiality during family involvement
T2 - A scoping review
AU - Hem, Marit Helene
AU - Molewijk, Bert
AU - Weimand, Bente
AU - Pedersen, Reidar
N1 - Funding Information: We would like to thank academic librarian Marte Ødegård (MØ), Medical Library, University of Oslo Library, for valuable support in performing the searches. We are grateful to associate professor emerita Lisbet Borge (LB), VID Specialized University, for contributing at an earlier phase to this project. Publisher Copyright: Copyright © 2023 Hem, Molewijk, Weimand and Pedersen.
PY - 2023/1/12
Y1 - 2023/1/12
N2 - Background: Despite evidence on the significant potential value of family involvement during the treatment of patients with severe mental illness, research has shown that family involvement is largely underused. The duty of confidentiality is reported to be a key barrier to family involvement. To develop more insight into this barrier, this scoping review focuses on the following question: What are the reported ethical challenges related to confidentiality when involving family in the treatment of patients with severe mental illness? Methods: A systematic search into primary studies was conducted using the following databases: Medline (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), and Web of Science core collection (Clarivate). The PICO (Population, Intervention, Comparison, Outcome) scheme and qualitative content analysis were used to make the ethical challenges more explicit. Results: Twelve studies?both qualitative and quantitative?were included. We identified the following main categories of ethical challenges: (1) the best interest of family members vs. confidentiality, (2) the patient's best interest vs. the right to confidentiality, (3) patient trust and alliance as a reason not to involve the relatives or not to share information, and (4) using confidentiality as a smokescreen. We also identified several subcategories and illustrative and concrete examples of ethical challenges. Conclusions: Through a systematic examination, we discovered various types of ethical challenges related to confidentiality when involving the family in the treatment of patients with severe mental illness. However, research on these ethical challenges and the constituents of these challenges remains limited and often implicit. An ethical analysis will create knowledge which may facilitate a more balanced and nuanced approach to respecting the principle of confidentiality while also considering other moral principles. The duty of confidentiality does not always have to be a major barrier to family involvement; this insight and using this ethical analysis in the training of healthcare professionals may benefit the patient, the family, and the services.
AB - Background: Despite evidence on the significant potential value of family involvement during the treatment of patients with severe mental illness, research has shown that family involvement is largely underused. The duty of confidentiality is reported to be a key barrier to family involvement. To develop more insight into this barrier, this scoping review focuses on the following question: What are the reported ethical challenges related to confidentiality when involving family in the treatment of patients with severe mental illness? Methods: A systematic search into primary studies was conducted using the following databases: Medline (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), and Web of Science core collection (Clarivate). The PICO (Population, Intervention, Comparison, Outcome) scheme and qualitative content analysis were used to make the ethical challenges more explicit. Results: Twelve studies?both qualitative and quantitative?were included. We identified the following main categories of ethical challenges: (1) the best interest of family members vs. confidentiality, (2) the patient's best interest vs. the right to confidentiality, (3) patient trust and alliance as a reason not to involve the relatives or not to share information, and (4) using confidentiality as a smokescreen. We also identified several subcategories and illustrative and concrete examples of ethical challenges. Conclusions: Through a systematic examination, we discovered various types of ethical challenges related to confidentiality when involving the family in the treatment of patients with severe mental illness. However, research on these ethical challenges and the constituents of these challenges remains limited and often implicit. An ethical analysis will create knowledge which may facilitate a more balanced and nuanced approach to respecting the principle of confidentiality while also considering other moral principles. The duty of confidentiality does not always have to be a major barrier to family involvement; this insight and using this ethical analysis in the training of healthcare professionals may benefit the patient, the family, and the services.
KW - confidentiality
KW - ethical challenges
KW - ethics
KW - ethics analysis
KW - family involvement
KW - scoping review
KW - severe mental illness
UR - http://www.scopus.com/inward/record.url?scp=85147086626&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fpubh.2022.960815
DO - https://doi.org/10.3389/fpubh.2022.960815
M3 - Review article
C2 - 36711422
SN - 2296-2565
VL - 10
JO - Frontiers in Public Health
JF - Frontiers in Public Health
M1 - 960815
ER -