title: Disclosure of congenital cleft lip and palate to Japanese patients: reported patient experiences and relationship to self-esteem.
abstract: BACKGROUND
  The present study investigated when and how Japanese people with cleft lip and palate (CL/P) learn that their condition is congenital; the perceived effects of withholding the CL/P diagnosis on patients; and whether the resulting social experience and self-esteem are related. A questionnaire survey was conducted in 71 adults with CL/P recruited through a hospital, a patients' association, and by snowball sampling.
  
  
  RESULTS
  The participants became aware of their physical difference in childhood, but many reported difficulty in understanding their condition. Participants reported that their families avoided the topic of diagnosis. Participants who understood their condition during childhood rather than in adulthood were significantly more likely to consider this scenario as positive (p < 0.001). Although stigmatising experiences were extremely painful, most patients hid their suffering, making it more difficult to obtain social support. Participants with high self-esteem were more likely to feel that they received adequate support.
  
  
  CONCLUSIONS
  It is important to explain the congenital nature of CL/P sufficiently and early. In addition, openness by the family about the diagnosis, rather than avoidance, may improve patients' self-esteem. Sufficient support from family, health care providers, and significant others is needed for patients to develop adequate self-esteem.
authors.affiliation: Community Nursing, Faculty of Nursing, Toho University, 4-16-20 Omori-Nishi, Ota-ku, Tokyo 143-0015, Japan. toomiya-tky@umin.ac.jp.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Omiya
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ito
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Yamazaki
mesh_terms: D000328:Adult; D000368:Aged; D002971:Cleft Lip / Q000523:psychology*; D002972:Cleft Palate / Q000523:psychology*; D030881:Disclosure; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D012649:Self Concept; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult