Primary care physicians' willingness to disclose oncology errors involving multiple providers to patients
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Bioethics and Medical Ethics | Health and Medical Administration | Health Services Administration | Health Services Research | Oncology | Primary Care
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.
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Citation: BMJ Qual Saf. 2015 Nov 3. pii: bmjqs-2015-004353. doi: 10.1136/bmjqs-2015-004353. Link to article on publisher's site
Communication, Diagnostic errors, Patient-centred care
Mazor, Kathleen M.; Roblin, Douglas W.; Greene, Sarah M.; Fouayzi, Hassan; and Gallagher, Thomas H., "Primary care physicians' willingness to disclose oncology errors involving multiple providers to patients" (2015). University of Massachusetts Medical School Faculty Publications. 867.