Error disclosure and family members' reactions: does the type of error really matter?

Abstract

Objective: To describe how Italian clinicians disclose medical errors with clear and shared lines of responsibility.

Methods: Thirty-eight volunteers were video-recorded in a simulated conversation while communicating a medical error to a simulated family member (SFM). They were assigned to a clear responsibility error scenario or a shared responsibility one. Simulations were coded for: mention of the term "error" and apology; communication content and affect using the Roter Interaction Analysis System. SFMs rated their willingness to have the patient continue care with the clinician.

Results: Clinicians referred to an error and/or apologized in 55% of the simulations. The error was disclosed more frequently in the clear responsibility scenario (p<0.02). When the "error" was explicitly mentioned, the SFM was more attentive, sad and anxious (p≤0.05) and less willing to have the patient continue care (p<0.05). Communication was more patient-centered (p<0.05) and affectively dynamic with the SFMs showing greater anxiety, sadness, attentiveness and respectfulness in the clear responsibility scenario (p<0.05).

Conclusions: Disclosing errors is not a common practice in Italy. Clinicians disclose less frequently when responsibility is shared and indicative of a system failure.

Practice implications: Training programs to improve disclosure practice considering the type of error committed should be implemented.

Keywords: Apology; Medical error; RIAS; Simulation; Truth disclosure.