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Daniels L, Marneffe W, Bielen S. Virtual reality evidence on the impact of physicians' open versus defensive communication on patients. HEALTH ECONOMICS, POLICY, AND LAW 2023:1-20. [PMID: 38037812 DOI: 10.1017/s1744133123000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Using virtual reality (VR) in an experimental setting, we analyse how communicating more openly about a medical incident influences patients' feelings and behavioural intentions. Using VR headsets, participants were immersed in an actual hospital room where they were told by a physician that a medical incident had occurred. In a given scenario, half of the participants were confronted by a physician who communicated openly about the medical incident, while the other half were confronted with the exact same scenario except that the physician employed a very defensive communication strategy. The employed technology allowed us to keep everything else in the environment constant. Participants exposed to open disclosure were significantly more likely to take further steps (such as contacting a lawyer to discuss options and filing a complaint against the hospital) and express more feelings of blame against the physician. At the same time, these participants rated the physician's communication skills and general impression more highly than those who were confronted with a defensive physician. Nevertheless, communicating openly about the medical incident does not affect trust in the physician and his competence, perceived incident severity and likelihood of changing physician and filing suit.
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Affiliation(s)
- Lotte Daniels
- Faculty of Business Economics, Hasselt University, 3500 Hasselt, Belgium
| | - Wim Marneffe
- Faculty of Business Economics, Hasselt University, 3500 Hasselt, Belgium
| | - Samantha Bielen
- Faculty of Business Economics, Hasselt University, 3500 Hasselt, Belgium
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Myren BJ, de Hullu JA, Bastiaans S, Koksma JJ, Hermens RPMG, Zusterzeel PLM. Disclosing Adverse Events in Clinical Practice: The Delicate Act of Being Open. HEALTH COMMUNICATION 2022; 37:191-201. [PMID: 33045852 DOI: 10.1080/10410236.2020.1830550] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Practicing a "safe" disclosure of adverse events remains challenging for healthcare professionals. In addition, knowledge on how to deliver a disclosure is still limited. This review focuses on how disclosure communication may be practiced based on the perspectives of patients and healthcare professionals. Empirical studies conducted between September 2008 and October 2019 were included from the databases PubMed, Web of Science and Psychinfo. After full text analysis and quality appraisal this scoping review included a total of 23 studies out of 2537 studies. As a first step, the needs of patients and the challenges of healthcare professionals with the practice of providing an effective disclosure were extracted from the empirical literature. Based on these findings, the review demonstrates that specific disclosure communication strategies on the level of interpersonal skills, organization, and supportive factors may facilitate healthcare professionals to provide optimal disclosure of adverse events. These may be relevant to provide patients with a tailored approach that accompanies their preferences for information and recognition. In conclusion, healthcare professionals may need training in interpersonal (verbal and nonverbal) communication skills. Furthermore, it is important to develop an open (organizational) culture that supports the communication of adverse events and disclosure as a standard practice.
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Affiliation(s)
- B J Myren
- Department of Gynaecology, Radboud University Medical Center
| | - J A de Hullu
- Department of Gynaecology, Radboud University Medical Center
| | - S Bastiaans
- Department of Gynaecology, Radboud University Medical Center
| | - J J Koksma
- Health Academy, Radboud University Medical Center
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Pype P, Pype K, Rowlands A, George R, Devisch I. COVID-19 and touch in medical encounters. PATIENT EDUCATION AND COUNSELING 2021; 104:464-466. [PMID: 33139145 PMCID: PMC7577861 DOI: 10.1016/j.pec.2020.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 05/29/2023]
Affiliation(s)
- Peter Pype
- Interprofessional Collaboration in Education and Practice, Department of Public Health and Primary Care - Ghent University Belgium, Corneel Heymanslaan 10, 9000, Gent, Belgium.
| | - Katrien Pype
- Social and Cultural Anthropology (IARA), Faculty of Social Sciences KU Leuven University Belgium, Parkstraat 45 Box 3615, 3000 Leuven, Belgium
| | - Angela Rowlands
- Queen Mary University of London Malta Campus, Triq L-Arcisqof Pietru Pace, Victoria, Gozo, VCT 2520, Malta
| | - Riya George
- Clinical Communication Skills, Barts and The London School of Medicine and Dentistry Robin Brook Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK
| | - Ignaas Devisch
- Philosophy of Medicine & Ethics (PME), Department of Public Health and Primary Care - Ghent University, Corneel Heymanslaan 10,9000 Gent, Belgium
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Hannawa AF. When facing our fallibility constitutes "safe practice": Further evidence for the Medical Error Disclosure Competence (MEDC) guidelines. PATIENT EDUCATION AND COUNSELING 2019; 102:1840-1846. [PMID: 31064681 DOI: 10.1016/j.pec.2019.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study pursues further empirical validation of the "Medical Error Disclosure Competence (MEDC)" guidelines. The following research questions are addressed: (1) What communicative skills predict patients' perceived disclosure adequacy? (2) To what extent do patients' adequacy perceptions predict disclosure effectiveness? (3) Are there any significant sex differences in the MEDC constructs? METHODS A sample of 193 respondents completed an online survey about a medical error they experienced in the past 5 years, and about the subsequent disclosure of that error to them. RESULTS One in four patients had experienced a medical error, only a third of them received a disclosure. Only interpersonal adaptability influenced disclosure adequacy, with a large effect size. Adequacy, in turn, predicted both patients' relational distancing and approach behaviors. Nonverbally skillful disclosures significantly decreased the likelihood of patient trauma. Expressions of remorse significantly increased patient resilience. Nonverbal skills (-) and a full account (+) predicted patients' tendency to harm themselves. Males were more reactive to disclosures than female patients. CONCLUSION MEDC guidelines-adherent disclosure communication maintains the provider-patient relationship, increase patient resilience, and decreases patient trauma after a medical error. PRACTICE IMPLICATIONS Given the results of this study, adherence to the MEDC-guidelines must be considered "safe practice."
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Do Written Disclosures of Serious Events Increase Risk of Malpractice Claims? One Health Care System's Experience. J Patient Saf 2019; 14:87-94. [PMID: 25831069 PMCID: PMC5965928 DOI: 10.1097/pts.0000000000000178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Supplemental digital content is available in the text. Objective This study aimed to determine whether Pennsylvania ACT 13 of 2002 (Mcare) requiring the written and verbal disclosure of “serious events” was accompanied by increased malpractice claims or compensation costs in a large U.S. health system. Main Outcomes and Measures The primary outcome was the rate of malpractice claims. The secondary outcome was the amount paid for compensation of malpractice claims. The analyses tested the relationship between the rate of serious event disclosures and the outcome variables, adjusted for the year of the event, category of claim, and the degree of “harm” related to the event. Results There were 15,028 serious event disclosures and 1302 total malpractice claims among 1,587,842 patients admitted to UPMC hospitals from May 17, 2002, to June 30, 2011. As the number of serious event disclosures increased, the number of malpractice claims per 1000 admissions remained between 0.62 and 1.03. Based on a matched analysis of claims that were disclosed and those that were not (195 pairs), disclosure status was significantly associated with increased claim payout (disclosures had 2.71 times the payout; 95% confidence interval, 1.56–4.72). Claims with higher harm levels H and I were independently associated with higher payouts than claims with lower harm levels A to D (11.15 times the payout; 95% confidence interval, 2.30–54.07). Conclusions and Relevance Implementation of a mandated serious event disclosure law in Pennsylvania was not associated with an overall increase in malpractice claims filed. Among events of similar degree of harm, disclosed events had higher compensation paid compared with those that had not been disclosed.
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Hesse C, Rauscher EA. The Relationships Between Doctor-Patient Affectionate Communication and Patient Perceptions and Outcomes. HEALTH COMMUNICATION 2019; 34:881-891. [PMID: 29461101 DOI: 10.1080/10410236.2018.1439269] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The current article combines the literature on doctor-patient communication and affectionate communication. Using Affection Exchange Theory (AET), the study predicts that the need for affection and the benefits of affectionate communication translate to the doctor-patient setting, proposing a series of relationships from both perceived doctor affectionate communication and affection deprivation to several patient outcome variables (patient perception of the doctor, patient communication with the doctor, and patient satisfaction/adherence). The results strongly supported the predictions for both affectionate communication and affection deprivation, with affectionate communication positively relating to most outcome measures and affection deprivation negatively relating to most outcome measures. Affection deprivation served as a moderator for the relationship between provider competence and patient satisfaction, although affectionate communication moderated the relationship between provider competence and patient adherence. Implications and possible directions for future research are discussed.
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Affiliation(s)
- Colin Hesse
- a Speech Communication , Oregon State University
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Vogel D, Meyer M, Harendza S. Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC MEDICAL EDUCATION 2018; 18:157. [PMID: 29970069 PMCID: PMC6029273 DOI: 10.1186/s12909-018-1260-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/18/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND Verbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter. The aim of the study was to analyze how well final year undergraduate medical students use skills of verbal and non-verbal communication during history-taking and whether these aspects of communication correlate with empathy and gender. METHODS During a three steps performance assessment simulating the first day of a resident 30 medical final year students took histories of five simulated patients resulting in 150 videos of physician-patient encounters. These videos were analyzed by external rating with a newly developed observation scale for the verbal and non-verbal communication and with the validated CARE-questionnaire for empathy. One-way ANOVA, t-tests and bivariate correlations were used for statistical analyses. RESULTS Female students showed signicantly higher scores for verbal communication in the case of a female patient with abdominal pain (p < 0.05), while male students started the conversations significantly more often with an open question (p < 0.05) and interrupted the patients significantly later in two cases than female students (p < 0.05). The number of W-questions asked by all students was significantly higher in the case of the female patient with abdominal pain (p < 0.05) and this patient was interrupted after the beginning of the interview significantly earlier than the patients in the other four cases (p < 0.001). Female students reached significantly higher scores for non-verbal communication in two cases (p < 0.05) and showed significantly more empathy than male students in the case of the female patient with abdominal pain (p < 0.05). In general, non-verbal communication correlated significantly with verbal communication and with empathy while verbal communication showed no significant correlation with empathy. CONCLUSIONS Undergraduate medical students display differentiated communication behaviour with respect to verbal and non-verbal aspects of communication and empathy in a performance assessment and special differences could be detected between male and female students. These results suggest that explicit communication training and feedback might be necessary to raise students' awareness for the different aspects of communication and their interaction.
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Affiliation(s)
- Daniela Vogel
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Universitätsklinikum Hamburg-Eppendorf III. Medizinische Klinik Martinistr. 52, D-20246 Hamburg, Germany
| | - Marco Meyer
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Universitätsklinikum Hamburg-Eppendorf III. Medizinische Klinik Martinistr. 52, D-20246 Hamburg, Germany
| | - Sigrid Harendza
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Universitätsklinikum Hamburg-Eppendorf III. Medizinische Klinik Martinistr. 52, D-20246 Hamburg, Germany
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Hill KM, Blanch-Hartigan D. Physician gender and apologies in clinical interactions. PATIENT EDUCATION AND COUNSELING 2018; 101:836-842. [PMID: 29241976 DOI: 10.1016/j.pec.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/27/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We examine whether patients have a preference for affective (i.e., focused on patient's emotions) or cognitive (i.e., focused on the process that led to the error) apologies that are dependent on the apologizing physician's gender. We hypothesize patients will prefer gender-congruent apologies (i.e., when females offer affective apologies and males offer cognitive apologies). METHODS We randomly assigned analogue patients (APs: participants instructed to imagine they were a patient) to read a scenario in which a female or male physician makes an error and provides a gender-congruent or incongruent apology. APs reported on their perceptions of the physician and legal intentions. RESULTS An apology-type and gender congruency effect was found such that APs preferred apologies congruent with the gender of the apologizing physician. An indirect effect of congruency on legal intentions through physician perceptions was confirmed (b=-0.24, p=0.02). CONCLUSION Our results suggest that physician gender plays a role in patient reactions to different apology types. PRACTICE IMPLICATIONS Apology trainings should incorporate how physician characteristics can influence how patients assess and respond to apologies.
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Affiliation(s)
- Krista M Hill
- Marketing Division, Babson College, Babson Park, USA.
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Han J, LaMarra D, Vapiwala N. Applying lessons from social psychology to transform the culture of error disclosure. MEDICAL EDUCATION 2017; 51:996-1001. [PMID: 28523743 DOI: 10.1111/medu.13345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/10/2017] [Accepted: 03/16/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT The ability to carry out prompt and effective error disclosure has been described in the literature as an essential skill among physicians that can lead to improved patient satisfaction, staff well-being and hospital outcomes. However, few studies have addressed the social psychology principles that may influence physician behaviour. METHODS The authors provide an overview of recent administrative measures designed to encourage physicians to disclose error, but note that deliberate practice, buttressed with lessons from social psychology, is needed to implement further productive behavioural changes. RESULTS Two main cognitive biases that may hinder error disclosure are identified, namely: fundamental attribution error, and forecasting error. Strategies to overcome these maladaptive cognitive patterns are discussed. The authors note that interactions with standardised patients (SPs) can be used to simulate hospital encounters and help teach important behavioural considerations. Virtual reality is introduced as an immersive, realistic and easily scalable technology that can supplement traditional curricula. Lastly, the authors highlight the importance of establishing a professional standard of competence, potentially by incorporating difficult patient encounters, including disclosure of error, into medical licensing examinations that assess clinical skills. CONCLUSIONS Existing curricula that cover physician error disclosure may benefit from reviewing the social psychology literature. These lessons, incorporated into SP programmes and emerging technological platforms, may improve training and evaluative methods for all medical trainees.
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Affiliation(s)
- Jason Han
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Denise LaMarra
- Standardized Patient Program, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
Errors are inherent in medicine due to the imperfectness of human nature. Health care providers may have a difficult time accepting their fallibility, acknowledging mistakes, and disclosing errors. Fear of litigation, shame, blame, and concern about reputation are just some of the barriers preventing physicians from being more candid with their patients, despite the supporting body of evidence that patients cite poor communication and lack of transparency as primary drivers to file a lawsuit in the wake of a medical complication. Proper error disclosure includes a timely explanation of what happened, who was involved, why the error occurred, and how it will be prevented in the future. Medical mistakes afford the opportunity for individuals and institutions to be candid about their weaknesses while improving patient care processes. When a physician takes the Hippocratic Oath they take on a tremendous sense of responsibility for the care of their patients, and often bear the burden of their mistakes in isolation. Physicians may struggle with guilt, shame, and a crisis of confidence, which may thwart efforts to identify areas for improvement that can lead to meaningful change. Coping strategies for providers include discussing the event with others, seeking professional counseling, and implementing quality improvement projects. Physicians and health care organizations need to find adaptive ways to deal with complications that will benefit patients, providers, and their institutions.
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Affiliation(s)
- Sevann Helo
- Division of Urology, Southern Illinois University, Springfield, IL, USA
| | - Carol-Anne E Moulton
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
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Morgan SE, Occa A, Mouton A, Potter J. The Role of Nonverbal Communication Behaviors in Clinical Trial and Research Study Recruitment. HEALTH COMMUNICATION 2017; 32:461-469. [PMID: 27314155 DOI: 10.1080/10410236.2016.1140266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Few studies have examined the communication behaviors of those who recruit for clinical trials and research studies, particularly of nonmedical professionals who often do the bulk of recruiting. This focus-group study of 63 recruiters analyzes the ways in which nonverbal communication behaviors support the process of recruitment, using the lens of communication accommodation theory. Results indicate that recruiters first "read" potential study participants' nonverbal communication for clues about their state of mind, then use nonverbal communication to achieve a sense of convergence. Specific nonverbal communication behaviors were discussed by recruiters, including smiling, variations in the use of voice, adjusting body position, the appropriate use of physical touch, the management of eye contact, and the effect of clothing and physical appearance. Implications for recruitment practice are discussed.
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Affiliation(s)
| | - Aurora Occa
- a School of Communication , University of Miami
| | - Ashton Mouton
- b Brian Lamb School of Communication , Purdue University
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13
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Lorié Á, Reinero DA, Phillips M, Zhang L, Riess H. Culture and nonverbal expressions of empathy in clinical settings: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:411-424. [PMID: 27693082 DOI: 10.1016/j.pec.2016.09.018] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 07/22/2016] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To conduct a systematic review of studies examining how culture mediates nonverbal expressions of empathy with the aim to improve clinician cross-cultural competency. METHODS We searched three databases for studies of nonverbal expressions of empathy and communication in cross-cultural clinical settings, yielding 16,143 articles. We examined peer-reviewed, experimental or observational articles. Sixteen studies met inclusion criteria. RESULTS Nonverbal expressions of empathy varied across cultural groups and impacted the quality of communication and care. Some nonverbal behaviors appeared universally desired and others, culturally specific. Findings revealed the impact of nonverbal communication on patient satisfaction, affective tone, information exchange, visit length, and expression decoding during cross-cultural clinical encounters. Racial discordance, patients' perception of physician racism, and physician implicit bias are among factors that appear to influence information exchange in clinical encounters. CONCLUSION Culture-based norms impact expectations for specific nonverbal expressions within patient-clinician dyads. Nonverbal communication plays a significant role in fostering trusting provider-patient relationships, and is critical to high quality care. PRACTICE IMPLICATIONS Medical education should include training in interpretation of nonverbal behavior to optimize empathic cross-cultural communication and training efforts should accommodate norms of local patient populations. These efforts should reduce implicit biases in providers and perceived prejudice in patients.
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Affiliation(s)
- Áine Lorié
- Massachusetts General Hospital/Harvard Medical School, Empathy and Relational Science Program, Department of Psychiatry, Boston, MA, USA
| | - Diego A Reinero
- Massachusetts General Hospital/Harvard Medical School, Empathy and Relational Science Program, Department of Psychiatry, Boston, MA, USA; New York University, Department of Psychology, New York, NY, USA
| | - Margot Phillips
- Massachusetts General Hospital/Harvard Medical School, Empathy and Relational Science Program, Department of Psychiatry, Boston, MA, USA
| | - Linda Zhang
- Massachusetts General Hospital/Harvard Medical School, Empathy and Relational Science Program, Department of Psychiatry, Boston, MA, USA
| | - Helen Riess
- Massachusetts General Hospital/Harvard Medical School, Empathy and Relational Science Program, Department of Psychiatry, Boston, MA, USA.
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Nezamodini ZS, Khodamoradi F, Malekzadeh M, Vaziri H. Nursing Errors in Intensive Care Unit by Human Error Identification in Systems Tool: A Case Study. ACTA ACUST UNITED AC 2016. [DOI: 10.17795/jjhs-36055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Hannawa AF, Shigemoto Y, Little TD. Medical errors: Disclosure styles, interpersonal forgiveness, and outcomes. Soc Sci Med 2016; 156:29-38. [PMID: 27017088 DOI: 10.1016/j.socscimed.2016.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/11/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
RATIONALE This study investigates the intrapersonal and interpersonal factors and processes that are associated with patient forgiveness of a provider in the aftermath of a harmful medical error. OBJECTIVE This study aims to examine what antecedents are most predictive of patient forgiveness and non-forgiveness, and the extent to which social-cognitive factors (i.e., fault attributions, empathy, rumination) influence the forgiveness process. Furthermore, the study evaluates the role of different disclosure styles in two different forgiveness models, and measures their respective causal outcomes. METHODS In January 2011, 318 outpatients at Wake Forest Baptist Medical Center in the United States were randomly assigned to three hypothetical error disclosure vignettes that operationalized verbally effective disclosures with different nonverbal disclosure styles (i.e., high nonverbal involvement, low nonverbal involvement, written disclosure vignette without nonverbal information). All patients responded to the same forgiveness-related self-report measures after having been exposed to one of the vignettes. RESULTS The results favored the proximity model of interpersonal forgiveness, which implies that factors more proximal in time to the act of forgiving (i.e., patient rumination and empathy for the offender) are more predictive of forgiveness and non-forgiveness than less proximal factors (e.g., relationship variables and offense-related factors such as the presence or absence of an apology). Patients' fault attributions had no effect on their forgiveness across conditions. The results evidenced sizeable effects of physician nonverbal involvement-patients in the low nonverbal involvement condition perceived the error as more severe, experienced the physician's apology as less sincere, were more likely to blame the physician, felt less empathy, ruminated more about the error, were less likely to forgive and more likely to avoid the physician, reported less closeness, trust, and satisfaction but higher distress, were more likely to change doctors, less compliant, and more likely to seek legal advice. CONCLUSION The findings of this study imply that physician nonverbal involvement during error disclosures stimulates a healing mechanism for patients and the physician-patient relationship. Physicians who disclose a medical error in a nonverbally uninvolved way, on the other hand, carry a higher malpractice risk and are less likely to promote healthy, reconciliatory outcomes.
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Affiliation(s)
- Annegret F Hannawa
- Center for the Advancement of Healthcare Quality and Patient Safety, Faculty of Communication Sciences, Università della Svizzera italiana (USI Lugano), Via G. Buffi 13, 6900 Lugano, Switzerland.
| | - Yuki Shigemoto
- Psychology Department, Texas Tech University, Lubbock, TX 79409-2051, USA.
| | - Todd D Little
- Institute for Measurement, Methodology, Analysis and Policy (IMMAP), Texas Tech University, Lubbock, TX 79409-2051, USA.
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Leone D, Lamiani G, Vegni E, Larson S, Roter DL. Error disclosure and family members' reactions: does the type of error really matter? PATIENT EDUCATION AND COUNSELING 2015; 98:446-452. [PMID: 25630608 DOI: 10.1016/j.pec.2014.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 12/03/2014] [Accepted: 12/31/2014] [Indexed: 06/04/2023]
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.
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Affiliation(s)
- Daniela Leone
- Department of Health Science, University of Milan, San Paolo University Hospital, Milan, Italy.
| | - Giulia Lamiani
- Department of Health Science, University of Milan, San Paolo University Hospital, Milan, Italy.
| | - Elena Vegni
- Department of Health Science, University of Milan, San Paolo University Hospital, Milan, Italy.
| | - Susan Larson
- Department of Public Health, John Hopkins University, Baltimore, USA.
| | - Debra L Roter
- Department of Public Health, John Hopkins University, Baltimore, USA.
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Hannawa AF. Disclosing medical errors to patients: effects of nonverbal involvement. PATIENT EDUCATION AND COUNSELING 2014; 94:310-313. [PMID: 24332933 DOI: 10.1016/j.pec.2013.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 10/28/2013] [Accepted: 11/19/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The purpose of this study was to test causal effects of physicians' nonverbal involvement on medical error disclosure outcomes. METHODS 216 hospital outpatients were randomly assigned to two experimental treatment groups. The first group watched a video vignette of a verbally effective and nonverbally involved error disclosure. The second group was exposed to a verbally effective but nonverbally uninvolved error disclosure. All patients responded to seven outcome measures. RESULTS Patients in the nonverbally uninvolved error disclosure treatment group perceived the physician's apology as less sincere and remorseful compared to patients in the involved disclosure group. They also rated the implications of the error as more severe, were more likely to ascribe fault to the physician, and indicated a higher intent to change doctors after the disclosure. CONCLUSION The results of this study imply that nonverbal involvement during medical error disclosures facilitates more accurate patient understanding and assessment of the medical error and its consequences on their health and quality of life. PRACTICE IMPLICATIONS In the context of disclosing medical errors, nonverbal involvement increases the likelihood that physicians will be able to continue caring for their patient. Thus, providers are advised to consider adopting this communication skill into their medical practice.
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Affiliation(s)
- Annegret F Hannawa
- Institute of Communication and Health (ICH), Faculty of Communication Sciences, University of Lugano, Lugano, Switzerland.
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Spitzberg BH. (Re)Introducing communication competence to the health professions. J Public Health Res 2013; 2:e23. [PMID: 25170494 PMCID: PMC4147740 DOI: 10.4081/jphr.2013.e23] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 02/08/2023] Open
Abstract
Despite the central role that communication skills play in contemporary accounts of effective health care delivery in general, and the communication of medical error specifically, there is no common or consensual core in the health professions regarding the nature of such skills. This lack of consensus reflects, in part, the tendency for disciplines to reinvent concepts and measures without first situating such development in disciplines with more cognate specialization in such concepts. In this essay, an integrative model of communication competence is introduced, along with its theoretical background and rationale. Communication competence is defined as an impression of appropriateness and effectiveness, which is functionally related to individual motivation, knowledge, skills, and contextual facilitators and constraints. Within this conceptualization, error disclosure contexts are utilized to illustrate the heuristic value of the theory, and implications for assessment are suggested. Significance for public healthModels matter, as do the presuppositions that underlie their architecture. Research indicates that judgments of competence moderate outcomes such as satisfaction, trust, understanding, and power-sharing in relationships and in individual encounters. If the outcomes of health care encounters depend on the impression of competence that patients or their family members have of health care professionals, then knowing which specific communicative behaviors contribute to such impressions is not merely important - it is essential. To pursue such a research agenda requires that competence assessment and operationalization becomes better aligned with conceptual assumptions that separate behavioral performance from the judgments of the competence of that performance.
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Affiliation(s)
- Brian H Spitzberg
- School of Communication, San Diego State University , San Diego, CA, USA
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Abstract
The attitudes of mental health care workers toward their clients may influence the quality of care they provide. There is growing recognition of the role of implicit attitudes in behavior toward people with stigmatized illnesses, such as mental illness, and of the need to measure these separately from explicit attitudes. Seventy-four mental health workers completed implicit and explicit measure of attitudes toward people with mental illness. The participants were also asked about their intention to help people with mental illness and their emotional reactions toward people with a mental illness. The findings show that the implicit attitudes of the health workers toward clients with a mental illness are somewhat negative despite the fact that their explicit attitudes are somewhat positive. Although both implicit and explicit attitudes predicted negative emotions, only implicit attitudes were related to helping intentions. This study highlights the association between implicit attitudes and behavioral intentions and confirms the importance of addressing implicit attitudes in mental health research.
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Zimmermann C, de Haes H, Visser A. Enhancing the patient position in the world of health care: contributions from the EACH conference 2010 in Verona. PATIENT EDUCATION AND COUNSELING 2011; 84:283-286. [PMID: 21854990 DOI: 10.1016/s0738-3991(11)00393-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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