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Open Access Research article

Feasibility of a patient decision aid regarding disclosure of personal health information: qualitative evaluation of the Health Care Information Directive

C Shawn Tracy1, Guilherme Coelho Dantas1 and Ross EG Upshur123*

Author Affiliations

1 Primary Care Research Unit, Sunnybrook and Women's College Health Sciences Centre 2075 Bayview Avenue, Room E3-49 Toronto, ON M4N 3M5 Canada

2 Department of Family and Community Medicine, University of Toronto 257 McCaul Street, 2nd Floor Toronto, ON M5T 2W5 Canada

3 Department of Public Health Sciences, University of Toronto McMurrich Building, 12 Queen's Park Crescent West Toronto, ON M5S 1A8 Canada

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BMC Medical Informatics and Decision Making 2004, 4:13  doi:10.1186/1472-6947-4-13

Published: 10 September 2004



Concerns regarding the privacy of health information are escalating owing both to the growing use of information technology to store and exchange data and to the increasing demand on the part of patients to control the use of their medical records. The objective of this study was to evaluate the Health Care Information Directive (HCID), a recently-developed patient decision aid that aims to delineate the level of health information an individual is willing to share.


We convened a series of four focus group meetings with several communities in a large Canadian city. A total of 28 men and women participated, representing health care consumer advocates, urban professionals, senior citizens, and immigrants who speak English as a second language. Data were analysed using qualitative methods.


Participants lacked substantial knowledge regarding the fate and uses of personal health information. They expressed mistrust concerning how their information will be used and protected. Several suggestions were made towards customizing the use of data according to specific needs rather than broad and full access to their charts. Furthermore, despite concern regarding the implementation of a tool like the HCID, participants were hopeful that a refined instrument could contribute to the improved regulation of health information.


This study indicated poor knowledge concerning the uses of personal health information, distrust concerning security provisions, and cautious support for a patient decision aid such as the HCID to improve control over health data.