Sandra Petronio

Permanent URI for this collection

https://hdl.handle.net/1805/14114

Managing Our Communication: Privacy, Disclosure, and Confidentiality

In our everyday life, we see examples of privacy breakdowns. Nevertheless, we also know that people value their private information and presume rights of ownership and control over this information. While these situations seem paradoxical, Dr. Sandra Petronio’s Communication Privacy Management (CPM) theory and research identify a systematic way to understand the puzzle of privacy management from a social-behavioral perspective. Grasping how people make decisions to confide, disclose, or protect private information is guided by a clear set of evidenced-based principles.

As the website for the new Communication Privacy Management Center illustrates, there are numerous studies using CPM theory and research across and within contexts such as families, healthcare, social media, organizations, and business. Researchers from 11+ countries have conducted CPM-based research adding an important dimension to understanding privacy management. CPM theory is geared toward providing a vehicle to translate research into practice thereby increasing ways people can utilize research findings. Consistently, the body of CPM research and translations illustrate the viability of the theory and emphasize how people can repair breakdowns thereby working to sustain ownership and control over their private information. Check out the CPM Center website for more information: www.cpmcenter.iupui.edu.

Dr. Petronio’s work to understand how people manage private information is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.

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'Translating scholarship into practice': An alternative metaphor
(http://trip.iupui.edu, 1999-05) Petronio, Sandra
Excerpt: Effectively translating scholarship can help people solve social problems. We may contribute to alleviating obstacles and dilemmas that people face. We may enhance the lives of others if communication scholars become translators of their own work or encourage others to function as transporters. Although we may initially concern ourselves with contributions that the communication discipline brings to the everyday world, this is a two-wy street. Not only might others benefit, but the discipline also stands to gain heartily from this investment. Showing how communication contributes to improve our understanding of the mundane and traumatic gives the discipline credibility in a wider arena. ... Through translation, we are able to preserve the integrity of the research and theory because it bridges knowledge production with knowledge utilization. Translating means that we take the knowledge discovered through research or theory and interpret it for everyday use.
Making Decisions for Hospitalized Older Adults: Ethical Factors Considered by Family Surrogates
(2013-08) Fritch, Jenna; Petronio, Sandra; Helft, Paul R.; Torke, Alexia M.
Background Hospitalized older adults frequently have impaired cognition and must rely on surrogates to make major medical decisions. Ethical standards for surrogate decision making are well delineated, but little is known about what factors surrogates actually consider when making decisions. Objectives To determine factors surrogate decision makers consider when making major medical decisions for hospitalized older adults, and whether or not they adhere to established ethical standards. Design Semi-structured interview study of the experience and process of decision making. Setting A public safety-net hospital and a tertiary referral hospital in a large city in the Midwest. Participants Thirty-five surrogates with a recent decision making experience for an inpatient age 65 and older. Measurements Key factors surrogates considered when making decisions. Interview transcripts were coded and analyzed using the grounded theory method of qualitative analysis. Results Surrogates considered patient-centered factors and surrogate-centered factors. Patient-centered factors included: 1) respecting the patient’s input, (2) using past knowledge of patient to infer the patient’s wishes, and (3) considering what is in the patient’s best interests. Some surrogates expressed a desire for more information about the patient’s prior wishes. Surrogate-centered factors included 1) Surrogate’s wishes as a guide, (2) The surrogate’s religious beliefs and/or spirituality, (3) The surrogate’s interests, (4) Family consensus and (5) Obligation and guilt. Conclusion These data show that surrogate decision making is more complex than the standard ethical models, which are limited to patient autonomy and beneficence. Because surrogates also imagine what they would want under the circumstances and consider their own needs and preferences, models of surrogate decision making must account for these additional considerations. Surrogates’ desire for more information about patient preferences suggests a need for greater advance care planning.
Timing of Do‐Not‐Resuscitate Orders for Hospitalized Older Adults Who Require a Surrogate Decision‐Maker
(2011-07) Torke, Alexia M.; Sachs, Greg A.; Helft, Paul R.; Petronio, Sandra; Purnell, Christianna E.; Hui, Siu; Callahan, Christopher M.
OBJECTIVES: To examine the frequency of surrogate decisions for in-hospital do-not-resuscitate (DNR) orders and the timing of DNR order entry for surrogate decisions. DESIGN: Retrospective cohort study. SETTING: Large, urban, public hospital. PARTICIPANTS: Hospitalized adults aged 65 and older over a 3-year period (1/1/2004–12/31/2006) with a DNR order during their hospital stay. MEASUREMENTS: Electronic chart review provided data on frequency of surrogate decisions, patient demographic and clinical characteristics, and timing of DNR orders.
A Conceptual Model of the Role of Communication in Surrogate Decision Making for Hospitalized Adults
(2012-04) Torke, Alexia M.; Petronio, Sandra; Sachs, Greg A.; Helft, Paul R.; Purnell, Christianna E.
OBJECTIVE: To build a conceptual model of the role of communication in decision making, based on literature from medicine, communication studies and medical ethics. METHODS: We proposed a model and described each construct in detail. We review what is known about interpersonal and patient-physician communication, described literature about surrogate-clinician communication, and discussed implications for our developing model. RESULTS: The communication literature proposes two major elements of interpersonal communication: information processing and relationship building. These elements are composed of constructs such as information disclosure and emotional support that are likely to be relevant to decision making. We propose these elements of communication impact decision making, which in turn affects outcomes for both patients and surrogates. Decision making quality may also mediate the relationship between communication and outcomes. CONCLUSION: Although many elements of the model have been studied in relation to patient-clinician communication, there is limited data about surrogate decision making. There is evidence of high surrogate distress associated with decision making that may be alleviated by communication-focused interventions. More research is needed to test the relationships proposed in the model. PRACTICE IMPLICATIONS: Good communication with surrogates may improve both the quality of medical decisions and outcomes for the patient and surrogate.
Communicating with Clinicians: The Experiences of Surrogate Decision‐Makers for Hospitalized Older Adults
(2012-08) Torke, Alexia M.; Petronio, Sandra; Purnell, Christianna E.; Sachs, Greg A.; Helft, Paul R.; Callahan, Christopher M.
OBJECTIVES: To describe communication experiences of surrogates who had recently made a major medical decision for a hospitalized older adult. DESIGN: Semistructured interviews about a recent hospitalization. SETTING: Two hospitals affiliated with one large medical school: an urban public hospital and a university-affiliated tertiary referral hospital. PARTICIPANTS: Surrogates were eligible if they had recently made a major medical decision for a hospitalized individual aged 65 and older and were available for an interview within 1 month (2-5 months if the patient died). MEASUREMENTS: Interviews were audio-recorded, transcribed, and analyzed using methods of grounded theory. RESULTS: Thirty-five surrogates were interviewed (80% female, 44% white, 56% African American). Three primary themes emerged. First, it was found that the nature of surrogate-clinician relationships was best characterized as a relationship with a "team" of clinicians rather than individual clinicians because of frequent staff changes and multiple clinicians. Second, surrogates reported their communication needs, including frequent communication, information, and emotional support. Surrogates valued communication from any member of the clinical team, including nurses, social workers, and physicians. Third, surrogates described trust and mistrust, which were formed largely through surrogates' communication experiences. CONCLUSION: In the hospital, surrogates form relationships with a "team" of clinicians rather than with individuals, yet effective communication and expressions of emotional support frequently occur, which surrogates value highly. Future interventions should focus on meeting surrogates' needs for frequent communication and high levels of information and emotional support.
Disclosing Medical Mistakes: A Communication Management Plan for Physicians
(2013-04) Petronio, Sandra; Torke, Alexia M.; Bosslet, Gabriel T.; Isenberg, Steven; Wocial, Lucia D.; Helft, Paul R.
Introduction: There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians’ own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. Methods: This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. Results: The steps are 1) physician preparation, such as talking about the physician’s emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. Conclusion: This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.
Navigating Ethics of Physician-Patient Confidentiality: A Communication Privacy Management Analysis
(2012-10) Petronio, Sandra; DiCorcia, Mark J; Duggan, Ashley
The ethics of physician-patient confidentiality is often fraught with contradictions. Privacy boundaries are not always clear, and patients can leave an interaction with their physicians feeling uncomfortable about the security of their private medical information. The best way to meet confidentiality and privacy management expectations that patients have may not be readily apparent. Without realizing it, a physician may communicate a patient's information in ways that are inconsistent with that person's perceptions of how his/her medical information should be treated. A proposed model is presented as a tool for physicians to better serve the privacy and confidentiality needs of their patients. This model depends on the communication privacy management (CPM) perspective that emerged from a 35-year research program investigating how people regulate and control information they consider private and confidential. A physician's use of this model enables the ability to establish a confidentiality pledge that can address issues in understanding the best way to communicate about privacy management with patients and more likely overcome potential negative outcomes.
Surrogate Decision Makers and Proxy Ownership: Challenges of Privacy Management in Health Care Decision Making
(Taylor and Francis, 2015-08) Bute, Jennifer J.; Petronio, Sandra; Torke, Alexia M.; Department of Communication Studies, School of Liberal Arts
This study explored the communicative experiences of surrogates who served as decision makers for patients who were unable to convey health information and choices about treatment options. Drawing on assumptions from communication privacy management theory (Petronio, 2002), 35 surrogates were interviewed to explore how they navigated the role of guardian of patients’ private health information while the patient was hospitalized. This research determined that not only are surrogates guardians and thereby co-owners of the patients’ private health information, they actually served in a “proxy ownership” role. Surrogates described obstacles to both obtaining and sharing private health information about the patient, suggesting that their rights as legitimate co-owners of the patients’ information were not fully acknowledged by the medical teams. Surrogates also described challenges in performing the proxy ownership role when they were not fully aware of the patient’s wishes. Theoretical and practical implications of these challenges are discussed.
Conceptualization and operationalization: utility of communication privacy management theory
(Elsevier, 2020-02) Petronio, Sandra; Child, Jeffrey T.; Communication Studies, School of Liberal Arts
Communication Privacy Management (CPM) theory explains one of the most important, yet challenging social processes in everyday life, that is, managing disclosing and protecting private information. The CPM privacy management system offers researchers, students, and the public a comprehensive approach to the complex and fluid character of privacy management in action. Following an overview of Communication Privacy Management framework, this review focuses on recent research utilizing CPM concepts that cross a growing number of contexts and illustrates the way people navigate privacy in action. Researchers operationalize the use of privacy rules and other core concepts that help describe and explain the ups and downs of privacy management people encounter.

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