Secrets and Their Consequences in Heathcare: A Scoping Review of Worker Experiences.
Kiriaki Stewart, David Evans, Qunyan Xu and 1 others
PMID 40159696WHAT IT FOUND
Patients often keep sexuality, HIV, abuse, alternative medicine or abortion decisions secret.
Workers felt unprepared, seeing disclosures as burden or privilege. Trust, private time and nonjudgmental response were linked to whether patients disclosed.
Key findings
01Sexuality was reported in 49 studies, medical concerns in 17, abuse in 6, and life choices or decisions in 4.
02Workers experienced disclosures as both a burden and a privilege; seven studies reported burden and six reported privilege.
03Workers managed disclosures by avoiding, facilitating or staying neutral; eight studies reported avoidance and all nine reported facilitation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a scoping review, so it maps what has been reported rather than testing whether any disclosure strategy works. The authors did not formally appraise the quality of the included studies. Screening and data extraction were mainly completed by the lead author, with only part of the process checked by others. The review protocol was not published. Only English publications were searched, and grey literature was not formally searched. The included studies varied widely in design, country and setting, so the themes may not transfer to every clinical service.
Declared interests
The authors declared no conflicts of interest. The work was funded by the Australian Government.
The easy way to misread this
Do not read this as a tested communication intervention. It reports themes from many studies. It does not show that asking about secrets, or any worker response, improves patient safety or wellbeing.