University of Massachusetts Medical School Faculty Publications

Title

Primary care physicians' willingness to disclose oncology errors involving multiple providers to patients

UMMS Affiliation

Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine

Publication Date

11-3-2015

Document Type

Article

Disciplines

Bioethics and Medical Ethics | Health and Medical Administration | Health Services Administration | Health Services Research | Oncology | Primary Care

Abstract

BACKGROUND: Full disclosure of harmful errors to patients, including a statement of regret, an explanation, acceptance of responsibility and commitment to prevent recurrences is the current standard for physicians in the USA.

OBJECTIVE: To examine the extent to which primary care physicians' perceptions of event-level, physician-level and organisation-level factors influence intent to disclose a medical error in challenging situations.

DESIGN: Cross-sectional survey containing two hypothetical vignettes: (1) delayed diagnosis of breast cancer, and (2) care coordination breakdown causing a delayed response to patient symptoms. In both cases, multiple physicians shared responsibility for the error, and both involved oncology diagnoses.

SETTING: The study was conducted in the context of the HMO Cancer Research Network Cancer Communication Research Center.

PARTICIPANTS: Primary care physicians from three integrated healthcare delivery systems located in Washington, Massachusetts and Georgia; responses from 297 participants were included in these analyses.

MAIN MEASURES: The dependent variable intent to disclose included intent to provide an apology, an explanation, information about the cause and plans for preventing recurrences. Independent variables included event-level factors (responsibility for the event, perceived seriousness of the event, predictions about a lawsuit); physician-level factors (value of patient-centred communication, communication self-efficacy and feelings about practice); organisation-level factors included perceived support for communication and time constraints.

KEY RESULTS: A majority of respondents would not fully disclose in either situation. The strongest predictors of disclosure were perceived personal responsibility, perceived seriousness of the event and perceived value of patient-centred communication. These variables were consistently associated with intent to disclose.

CONCLUSION: To make meaningful progress towards improving disclosure; physicians, risk managers, organisational leaders, professional organisations and accreditation bodies need to understand the factors which influence disclosure. Such an understanding is required to inform institutional policies and provider training.

Rights and Permissions

Citation: BMJ Qual Saf. 2015 Nov 3. pii: bmjqs-2015-004353. doi: 10.1136/bmjqs-2015-004353. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Keywords

Communication, Diagnostic errors, Patient-centred care

Journal/Book/Conference Title

BMJ quality and safety

PubMed ID

26534996