title: Balancing digital information-sharing and patient privacy when engaging families in the intensive care unit.
abstract: Patients in intensive care units (ICUs) may lack decisional capacity and may depend on proxy decision makers (PDMs) to make medical decisions on their behalf. High-quality information-sharing with PDMs, including through such means as health information technology, could improve communication and decision making and could potentially minimize the psychological consequences of an ICU stay for both patients and their family members. However, alongside these anticipated benefits of information-sharing are risks of unwanted disclosure of sensitive information. Approaches to identifying the optimal balance between access to digital health information to facilitate engagement and protecting patient privacy are urgently needed. We identified eight themes that should be considered in balancing health information access and patient privacy: 1) potential benefits to patients from PDM data access; 2) potential harms to patients from such access; 3) the moral status of families within the patient-clinician relationship; 4) the scope of relevant information provided to PDMs; 5) issues around defining PDMs' authority; 6) methods for eliciting and documenting patient preferences about their family's information access; 7) the relevance of methods for ascertaining the identity of PDMs; and 8) the obligations of hospitals to prevent privacy breaches by PDMs. We conclude that PDMs should typically have access to health information from the current episode of care when the patient is decisionally impaired, unless the patient has previously expressed a clear preference that PDMs not have such access.
authors.affiliation: Center for Humanizing Critical Care, Intermountain Healthcare, 5121 S. Cottonwood St, Murray, UT USA and Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA samuel.brown@imail.org.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Brown
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Hanan J
authors.initials: HJ
authors.lastname: Aboumatar
authors.affiliation: University of Utah S.J. Quinney College of Law, Salt Lake City, UT, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Francis
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Halamka
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Ronen
authors.initials: R
authors.lastname: Rozenblum
authors.affiliation: ARDS Foundation, Chicago, IL, USA.
authors.forename: Eileen
authors.initials: E
authors.lastname: Rubin
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sarnoff Lee
authors.affiliation: Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD USA Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD USA Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sugarman
authors.affiliation: San Francisco Medical Center, University of California, San Francisco, CA, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Turner
authors.affiliation: University of Utah S.J. Quinney College of Law, Salt Lake City, UT, USA.
authors.forename: Micah
authors.initials: M
authors.lastname: Vorwaller
authors.affiliation: Gordon and Betty Moore Foundation, San Francisco, CA, USA and Department of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
mesh_terms: D003219:Confidentiality; D003657:Decision Making; D005190:Family; D006801:Humans; D033181:Information Dissemination; D007362:Intensive Care Units; D057240:Patient Preference; D011368:Professional-Family Relations; D019727:Proxy
keywords: access; digital information; ethics; intensive care unit; patient engagement; patient privacy; patient-centered care; personal health records; shared decision making