Understanding confidentiality: Perspectives of African American adolescents and their parents

Purpose: To identify adolescents' and parents' understanding of confidentiality in the patient/ doctor relationship. Methods: In the teen clinic of an academic hospital, questionnaires were administered separately to 50 accompanying parents and 50 adolescents aged 13 to 17 years. The true/false questions were designed to identify both adolescents' and parents' perceptions of the general breadth and limitations of confidentiality and specifically related to selected high-risk behaviors. Results: Most adolescents and parents understood confidentiality to mean that conversations, testing and treatments about certain aspects of health care could be kept private between a doctor and patient. However, most parents felt that confidentiality guidelines did not apply to patients under 18 years. In contrast to 36% of adolescents, 96% of parents believe that the doctor would discuss any conversation the doctor had with the patient that might be important to the parent in spite of adolescents' wish for them not to be told. Parent/adolescent dyads agreed regarding the general value of a confidential adolescent/doctor relationship and the application of confidentiality to certain topics but disagreed with respect to others. Conclusions: The adolescents and parents in this study have a good understanding of the meaning of confidentiality but are less clear on its application to the adolescent patient/doctor relationship. Nearly all adolescents and their parents appreciate the circumstances under which confidentiality will be breached. The protections confidentiality offers adolescents are understood less well by both parties, but parents seem to have a greater degree of misunderstanding. Parents believe that the doctor will inform them about many of their adolescents' high-risk behaviors. These false impressions may lead to assumptions, miscommunication, and conflict in the adolescent patient/doctor/parent triad. (c) 2006 Society for Adolescent Medicine. All rights reserved.