Background: Unanticipated outcomes and harms resulting from medical care are inevitable. Disclosure of those outcomes to patients is increasingly expected and required, but this practice remains uncommon and few physicians have had disclosure training. Failure to conduct disclosure consistently and well represents a fundamental threat to patient-centered care. Many have asserted that improving disclosure could increase patient satisfaction and reduce malpractice claims, but empirical evidence for these claims is lacking. No prior studies have assessed the quality of actual disclosures, hampering efforts to improve the disclosure process. Objectives: We propose a randomized trial of training physicians in disclosure with the following specific aims: 1) to determine whether physician communication training in disclosing unanticipated outcomes to patients affects patient satisfaction with disclosure;2) to explore whether physician communication training in disclosing unanticipated outcomes to patients affects malpractice claims;3) to explore whether characteristics of the event (severity of harm, presence of error), the physician, patient, and the environment independently affect the relationship between unanticipated outcome disclosure training and patient satisfaction. Methods: Participants will be 400 surgeons and interventional physicians in Colorado (who obtain liability insurance through COPIC) and in Washington (UW Medicine). The intervention includes: a) 2-hour disclosure training webcast;b) practice and feedback with two standardized patients;and c) a refresher training webcast mid-project. The primary outcome will be patient satisfaction with a disclosure they experience, as measured with the Patient Assessment of Disclosure Quality, a psychometrically sound instrument. The secondary outcome will be the incidence of malpractice claims in the subsequent 24 months. Multivariate regression analysis will also be used to examine the effects of patient, event, and physician characteristics on patient satisfaction with disclosure. Implications and Impact: This study will be the first to measure the quality of actual disclosures and assess whether physician training improves the disclosure process. The proposed project brings together leading researchers in medical error, malpractice, and communication skills training with two industry partners--a major malpractice insurance company and TMIT, a leader in web-based safety education. The findings will be widely applicable to training physicians to meet the increasing demands for effective disclosure.

Public Health Relevance

Failure to communicate effectively with patients following unanticipated outcomes threatens patient trust, impairs quality, and may increase malpractice risk. This study will provide doctors with intensive web-based training in disclosure communication, and will measure key outcomes including patient satisfaction with disclosure and malpractice claims. It will be the first study to measure the quality of actual disclosures of unanticipated outcomes to patients.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS016506-04
Application #
8145644
Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Burgess, Denise
Project Start
2008-09-30
Project End
2013-09-29
Budget Start
2011-09-30
Budget End
2013-09-29
Support Year
4
Fiscal Year
2011
Total Cost
Indirect Cost
Name
University of Washington
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Lu, Dave W; Guenther, Elisabeth; Wesley, Allen K et al. (2013) Disclosure of harmful medical errors in out-of-hospital care. Ann Emerg Med 61:215-21
Gallagher, Thomas H; Levinson, Wendy (2013) Physicians with multiple patient complaints: ending our silence. BMJ Qual Saf 22:521-4
Prouty, Carolyn D; Foglia, Mary Beth; Gallagher, Thomas H (2013) Patients' experiences with disclosure of a large-scale adverse event. J Clin Ethics 24:353-63
Brown, Stephen D; Lehman, Constance D; Truog, Robert D et al. (2012) Stepping out further from the shadows: disclosure of harmful radiologic errors to patients. Radiology 262:381-6
Souter, Karen J; Gallagher, Thomas H (2012) The disclosure of unanticipated outcomes of care and medical errors: what does this mean for anesthesiologists? Anesth Analg 114:615-21
Dintzis, Suzanne M; Stetsenko, Galina Y; Sitlani, Colleen M et al. (2011) Communicating pathology and laboratory errors: anatomic pathologists' and laboratory medical directors' attitudes and experiences. Am J Clin Pathol 135:760-5
Bell, Sigall K; Delbanco, Tom; Anderson-Shaw, Lisa et al. (2011) Accountability for medical error: moving beyond blame to advocacy. Chest 140:519-526
Dudzinski, Denise M; Hebert, Philip C; Foglia, Mary Beth et al. (2010) The disclosure dilemma--large-scale adverse events. N Engl J Med 363:978-86
Mastroianni, Anna C; Mello, Michelle M; Sommer, Shannon et al. (2010) The flaws in state 'apology' and 'disclosure' laws dilute their intended impact on malpractice suits. Health Aff (Millwood) 29:1611-9
Dintzis, Suzanne M; Gallagher, Thomas H (2009) Disclosing harmful pathology errors to patients. Am J Clin Pathol 131:463-5

Showing the most recent 10 out of 12 publications