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Increasing Patient-Clinician Concordance About Medical Error Disclosure Through the Patient TIPS Model

Martinez, William MD, MS*; Browning, David MSW, BCD; Varrin, Pamela PhD; Sarnoff Lee, Barbara LICSW; Bell, Sigall K. MD†,§

doi: 10.1097/PTS.0000000000000284
Original Study
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Objective To test whether an educational model involving patients and family members (P/F) in medical error disclosure training for interprofessional clinicians can narrow existing gaps between clinician and P/F views about disclosure.

Method Parallel presurveys/postsurveys using Likert scale questions for clinicians and P/F.

Results Baseline surveys were completed by 91% (50/55) of clinicians who attended the workshops and 74% (65/88) of P/F from a hospital patient and family advisory council. P/F’s baseline views about disclosure were significantly different from clinicians’ in 70% (7/10) of the disclosure expectation items and 100% (3/3) of the disclosure vignette items. For example, compared with clinicians, P/F more strongly agreed that “patients want to know all the details of what happened” and more strongly disagreed that “patients find explanation(s) more confusing than helpful.” In the medication error vignette, compared with clinicians, P/F more strongly agreed that the error should be disclosed and that the patient would want to know and more strongly disagreed that disclosure would do more harm than good (all P < 0.05). After the workshop, P/F and clinician views about information sharing, fallibility, truth telling, and threshold for disclosure showed greater concordance, with significant differences remaining in less than half of the expectation items and none of the vignette responses.

Discussion Even with self-selecting clinicians, collaborative learning with P/F highlights important differences in patient and clinician baseline perspectives about medical error disclosure and brings patient and clinicians views closer together.

From the *Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

Institute for Professionalism and Ethical Practice, Children’s Hospital Boston

Department of Social Work, Beth Israel Deaconess Medical Center

§Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Correspondence: William Martinez, MD, MS, Vanderbilt University Medical Center, Division of General Internal Medicine and Public Health, 1215 21st Avenue South, 6000 Medical Center East, North Tower, Nashville, TN (e-mail: william.martinez@vanderbilt.edu).

The authors disclose no conflict of interest.

Funding for Dr Martinez was provided by an institutional National Research Service Award (T32HP10251). The funding sources had no role in the design of this study or its execution, analyses, interpretation of the data, or decision to submit results. Funding for Dr Bell was provided by The Schwartz Center and the Institute for Professionalism and Ethical Practice, Boston Children’s Hospital, both in Boston, MA.

Online date: May 11, 2017

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