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A comparative review of patient and provider perspectives on apology in medical error disclosure

Sierminski, Elizabeth (2017) A comparative review of patient and provider perspectives on apology in medical error disclosure. Master Essay, University of Pittsburgh.

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Abstract

Background: Adverse health events are estimated to be the third leading cause of injury in the US. Both patients and physicians experience pronounced psychological distress in the wake of adverse events. Traditionally, physicians and institutions have revealed little, if any, information to patients, as a protective measure against malpractice claims. This practice often signals the end of the physician-patient relationship and leaves both parties feeling guilty, afraid, and alone.
Proactive adverse event disclosure is an emerging best practice. The Agency for Healthcare Research and Quality (AHRQ) regards apology a necessary component of disclosure and 36 states have enacted laws excluding words of apology from admissible evidence of malpractice liability, but only about 11% of injured patients receive one. Evidence from psychology, communication, and other fields, suggests apology is a constructive coping mechanism.
This essay will provide a patient and provider-centric introduction to adverse event research and policy. It will then present a rapid review of descriptive and empirical studies on patient and provider perspectives on apology, with the goal of shedding light on disconnects, to inform future research, policy, and interventions. This essay has public health significance because it is the first literature review to focus exclusively on descriptive and empirical studies on US patient and physician perspectives on apology in adverse event disclosure.
Methods: A PubMed literature search was conducted using the search terms medical error, apology, and disclosure. Selections were limited to peer-reviewed, empirical studies relevant to patient and provider perspectives on apology for adverse events occurring in adult populations in US inpatient or equivalent hospitals. Articles on obstetric errors were excluded because they produce an incomparable psychological response.
Results: The search returned 16 studies. Patient studies primarily tested the association between apology and psychological, physician-patient, and intent to sue outcomes. Physician articles primarily focused on intent and ability to deliver an apology.
Conclusion: Current research is sparse and limited in generalizability but some themes emerged. Apology is strongly associated with improved intrapersonal and interpersonal patient outcomes. Apology is not strongly associated with intent to sue. Semantics are a primary concern for physicians because they fear admitting fault will drive the patient to file a malpractice claim. However, research suggests that expressions of empathy and nonverbal cues are more meaningful to patient outcomes, including intent to sue. More research is needed in all areas but qualitative analyses of physician experiences with apology are especially lacking.

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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Sierminski, Elizabethers111@pitt.eduers111
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairFelter, Elizabeth M.emfelter@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberDegenholtz, Howard B.degen@pitt.eduUNSPECIFIEDUNSPECIFIED
Date: December 2017
Date Type: Submission
Defense Date: 17 December 2017
Submission Date: 27 November 2017
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 64
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: medical error, medical error disclosure, disclosure, communication and resolution, apology
Date Deposited: 17 Jul 2018 16:56
Last Modified: 17 Jul 2018 16:56
URI: http://d-scholarship.pitt.edu/id/eprint/33638

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