- Title
- Discussing adverse outcomes with patients
- Creator
- Gallagher, Thomas H.; Girgis, Afaf
- Relation
- Handbook of Communication in Oncology and Palliative Care p. 327-337
- Relation
- http://www.oup.com.au/titles/academic/medicine/9780199238361
- Publisher
- Oxford University Press
- Resource Type
- book chapter
- Date
- 2010
- Description
- Few communication challenges are as difficult for healthcare providers as talking with patients about adverse events, especially when the adverse event was due to a medical error. Ethicists and professional organizations have long endorsed open communication with patients about adverse events and errors in their care. Recently, however, there has been a substantial increase in attention being paid to transparent communication with patients. Many countries, including Australia, the United Kingdom, and Canada have undertaken major disclosure initiatives. The Joint Commission, the body responsible for the accreditation of most US healthcare facilities, now requires that patients be informed of all outcomes in their care, including 'unanticipated outcomes'. Yet there is increasing evidence of a significant gap between expectations for open communication with patients and actual clinical practice. Several studies in a variety of countries suggest that less than one-third of adverse events due to errors are disclosed to patients. Other research suggests that when these conversations do take place, they often fall short of meeting patient expectations. Healthcare workers endorse the general concept of disclosure, but struggle with how to turn this principle into practice, especially when it comes to choosing their words when talking with patients about adverse events. Significant fear persists among both healthcare workers and institutions that more open disclosure of adverse events and errors could increase the likelihood of a medical malpractice suit being filed. Communication dilemmas associated with disclosure of adverse events and errors to patients exist at multiple levels, ranging from the individual patient-provider encounter, to issues of national health policy. In this chapter, we will consider what is currently known about patients' and providers' attitudes and experiences with disclosure, explore the special aspects of disclosure in the oncology context, consider disclosure in an inter-professional context, discuss how healthcare institutions are responding to calls for greater transparency, what is known about the impact of disclosure on outcomes including litigation, and present some of the health policy challenges associated with disclosure. The chapter concludes by considering a disclosure case study, and discussing next steps for disclosure in oncology.
- Subject
- communication; adverse events; disclosure; healthcare workers; patient expectations
- Identifier
- http://hdl.handle.net/1959.13/932894
- Identifier
- uon:11498
- Identifier
- ISBN:9780199238361
- Language
- eng
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