Table 2 Descriptive summary of the included studies for the review
Author and year | Country of origin of article | Setting (acute/ community) | Study method | Objectives of the study | Participant information | Outcomes, key findings (listed under major themes) and recommendations |
|---|---|---|---|---|---|---|
Bryant et al., 2021 [25] | Australia | Acute—Haematological Oncology Treatment Centre | Mixed method research | To describe patients with confirmed haematological cancer who experienced an adverse event and how it was handled by the health-care organisation | Two consecutive self-administered questionnaires were distributed during patients' clinic visits, assessing demographics, disease and treatment characteristics, as well as patient safety-related questions, with a total of 166 patients participating | The results suggest there is significant scope for improvement in communication with parents about their rights and medical complaints Major themes—OD as a future oriented conversation, Quality of communication |
Claringbold, 2023 [26] | Australia | Acute and Community—target population is in the community however, patients recruited from clinic | Qualitative research | To understand women's responses to their interval cancer diagnosis and their feelings about the screening program | 276 women | Feedback regarding the open disclosure process was largely positive as many expressed their appreciation of receiving the letter and opportunity to provide feedback via the questionnaire Major themes—timeliness of disclosure, quality of communication |
Elwy, 2014 [18] | United States | Acute—Veteran Affairs Hospitals | Qualitative research | 27 veteran patients and family members | 10 Themes included: better facility preparation (pre-crisis stage), creating rapid communication, modifying language as part of the disclosure, addressing perceptions of harm, reducing complexity in the disclosure process, and seeking assistance from others (initial event stage), managing communication with others (maintenance stage), decreasing effects on staff, improving trust (resolution stage) and addressing identified needs (evaluation stage) Major themes—timeliness of disclosure, quality of communication, importance of accommodating patient/family support needs, organisational arrangements in place as part of OD process and OD as a future oriented conversation | |
Etchegaray, 2014 [27] | United States (Texas) | Acute—University of Texas | Qualitative research | To determine how patients and family members were already included in the event analysis and to obtain insights into how to improve their experiences | 5 patients and 4 family members | Hospitals should give patients and families information about what changes will be implemented to prevent similar errors from happening in the future Major themes—timeliness of disclosure, quality of communication, organisational arrangements in place as part of OD process and OD as a future oriented conversation |
Formanek, 2008, [28] | United States | Acute—Kaiser Permanente Facility | Case Report | To distinguish between the curing role and caring role, Expand the caring role as professionals as teams and as a healthcare system, especially following an adverse event | 90-year-old female patient and her daughter who went through the adverse event | Appreciated the in-person apology and telling the truth of the events and expected to know what changes would be made so it wouldn't help to someone else and that the story will help physicians to think more about patients Major themes—organisational arrangements in place as part of OD process |
Gallagher, 2009, [29] | United States | Acute—Beth Israel Deaconess Medical Centre | Case report | To highlight the challenges of communicating with patients after errors | 62-year-old female patient | Patient received an immediate recognition and apology. Her only regret was they never had an opportunity to speak to the doctor who had mismarked the spot. However, it really established a sense of trust Major themes—timeliness of disclosure, quality of communication, OD as a future oriented conversation |
Hagensen, 2018, [30] | Norway | Acute | Qualitative research | To illuminate conditions surrounding adverse events from the patient perspective. Key aspects include how patients perceive the occurrence of events and the responses from health personnel and the health service | 15 patients, 9 female, 6 male | Patients felt clinician's and health services' avoidance or lack of response, signs of denial of responsibility and use of loyalty systems to largely support and protect each other Major themes—timeliness of disclosure, quality of communication, importance of accommodating patient/family support needs |
Hannawa, 2019 [31] | Switzerland | Acute and Community | Mixed method research | To test the MEDC model and validate the extent to which physician's ability to adapt to their patients expressed needs and expectations during an OD. (grounded in a theoretically based Medical Error Disclosure Competence (MEDC) model) | A total of 193 patients participated in an online survey to assess their experiences with medical errors over the past five years and the subsequent disclosure of these errors to them | MEDC guideline adherent disclosure communication maintains the provider patient relationship, increases patient resilience, and decreases patient trauma after a medical error Major themes—importance of accommodating patient/family support needs, and OD as a future oriented conversation |
Iedema, 2012 [32] | Australia | Acute | Case Study | To understand the possibilities from a disclosure communication and to understand from a patient's perspective what went wrong and what went right | 120 patients and family members | The disclosure process was more of a dialogue which allowed the patient to feel like she could develop her judgements and turn it into specific issues in the service that needs to be addressed. Major themes—importance of accommodating patient/family support needs and OD as a future oriented conversation |
Iedema et al., 2011 [33] | Australia | Acute and Community | Qualitative research | To understand what patients and family members know about problems and failures in healthcare | 119 patients and families | Patients and family members need access to structured processes to ensure the dialogue with health service personnel about perceived risks, problems and incidents. Major themes—quality of communication, importance of accommodating patient/family support needs, organisational arrangements in place as part of OD process |
Iedema et al., 2011 [33] | Australia | Acute and Community | Qualitative research | To investigate the patients' and family members' perceptions and experiences of open disclosure of healthcare incidents and to derive principles of effective disclosure | 39 patients and 80 family members | All patient and family member interviews except one expressed concern about process of incident disclosure. Concerns included: inadequate preparation, inappropriate disclosure for unexpected outcomes, lack of follow up support, lack of appropriate closure, insufficient integration of open disclosure with improvement of patient safety Major themes- quality of communication, importance of accommodating patient/family support needs, organisational arrangements in place as part of OD process |
Iedema et al., 2008, [34] | Australia | Acute—across 21 hospital sites | Qualitative research | To explore patients' and family members' perceptions of Open Disclosure of adverse events that occurred during their healthcare | 23 patients and family members | Full apology and adequate recognition of what the adverse event means to them is needed as well as a clear plan of how the patient will be supported after the adverse event, physically emotionally, clinically and financially. Major themes—quality of communication, importance of accommodating patient/family support needs, organisational arrangements in place as part of OD process |
Iedema et al., 2008 [20] | Australia | Acute—across 21 hospital sites | Qualitative research | To determine which aspects of OD work for patients and healthcare based on an evaluation of the National OD pilot | 23 patients and family members | Open disclosure works when patients and family members are shows respect by offering immediate and sincere apology. It is conducted as much as possible, and consumers can appoint a support person. Major themes—timeliness of disclosure, quality of communication, importance of accommodating patient/family support needs, organisational arrangements in place as part of OD process |
Kim 2021, [35] | South Korea | Acute—hospital | Qualitative research | To identify patients' and families' experiences regarding disclosure of patient safety incidents | 15 patients and their families | Concrete protocols and policies must be developed to protect patients and their families from physical/psychological injury and the stress experienced due to patient safety incidents. Major themes—importance of accommodating patient/family support needs, organisational arrangements in place as part of OD process |
Kooienga 2011 [23] | US | Acute | Qualitative research | To explore the community members perceptions of error | 30 participants | Medical error was perceived overall as a lack of communication, missed communication or poor interpersonal communication styles by physicians or other healthcare providers. Negative attitudes directed towards themselves and family members with huge form of lack of respect, blame and stigma. Major themes—quality of communication |
Lyu 2017 [36] | US | Acute and Community | Qualitative research | To describe patient's perceptions regarding disclosure and their actions after harm | 236 respondents | Perception of an inadequate apology—patients think that hospitals and clinicians do not disclosure completely information regarding their incident and there needs to be increased transparency and improved communications. Major themes—quality of communication, importance of accommodating patient/family support needs, organisational arrangements in place as part of OD process |
Moore 2017 [37] | New Zealand | Acute | Qualitative Research | To explore factors that facilitate and impede reconciliation following patient safety incidents and to identify factors to facilitate reconciliation following patient safety incidents for strengthening institution-led alternatives to malpractice litigation | 62 patients | Policymakers favour non-litigation approaches, stressing that apologies shouldn't replace necessary remedial actions. Flexible, best-practice guidelines should ensure all steps are followed without a 'one size fits all' approach Major themes—timeliness of disclosure, quality of communication and OD as a future oriented conversation |
Maguire, 2016 [38] | US | Acute—Veterans Health | Qualitative research | To evaluate VA's national large scale disclosure policy and identify gaps and successes in its implementation | 97 patients | e greatest costs of disclosure of these events: trust in the healthcare organisation. delays in discovering issues and then in notifying patients, caught the mistake and improved, learning more about the event and how the detail helped them to feel more confident. Major themes—timeliness of disclosure, quality of communication, importance of accommodating patient/family support needs, organisational arrangements in place as part of OD process |
Mahmudah, 2022 [39] | South Korea | Acute and Community | Qualitative research | Explore the various types and frequency of patient safety incidents during a cancer screening health examination for the public | 11 patients | There was a significant association between the judgment of medical error occurrence (P = .038) and level of patient harm (P = .032) both in experience by family members and total experience of patient safety incidents. Major themes—quality of communication |
Mazor, 2013 [40] | US | Acute—Cancer Care | Qualitative research | To examine whether patients consider recommended responses to be appropriate and desirable and whether clinicians’ actions after adverse events are consistent with recommendations | 78 patients | Patients valued apology, expression of remorse, empathy and caring, explanation acknowledgement of responsibility and efforts to prevent recurrences—but these were often missing. Clinicians' responses continue to fall short of expectations. Major themes—quality of communication, importance of accommodating patient/family support needs, and OD as a future oriented conversation |
Moore, 2017 [24] | US | Acute—3 Hospitals | Qualitative research | To explore the experiences of patients and family members with medical injuries and communication and resolution programmes (CRP) to understand the different aspects of institutional responses to injury that promoted and impeded reconciliation | 27 patients, 3 family members | Satisfaction with OD was highest when communications were empathetic and no adversarial, including compensation negotiations. Patients and families expressed a strong need to be heard and expected the attending physician to listen without interrupting during conversations about the event. Major themes—quality of communication, importance of accommodating patient/family support needs and OD as a future oriented conversation |
Okamoto, 2011 [41] | Japan | Acute and Community | Quantitative research | To examine the perceptions of persons who experienced a medical error and elements that may serve to open communication with those who experience a medical error in Japan | A detailed questionnaire was administered to 80 patients who had experienced adverse events | Following an immediate disclosure of medical error by a senior medical personnel and medical provider should create an environment to continue communication in order to accommodate shifting perspectives of those who experienced the error. Major themes—timeliness of disclosure, organisational arrangements in place as part of OD process |
Piper, 2014 [21] | Australia | Acute and Community (from the 100 patient stories study) | Retrospective qualitative study | To analyse rural patients' and their families' experiences of open disclosure and offer recommendations to improve disclosure in rural areas | Subset of 13 /100 patient participants from rural or regional area | OD processes were generally initiated via letter and conducted over phone 0 which patients did not like. Patients and family members were often uncertain who was attending it on telephone and why they were there. Staff involved should be there if they wanted to patients to feel it was sincere. OD often had to be initiated by the patient of family themselves. Major themes—quality of communication, organisational arrangements in place as part of OD process and OD as a future oriented conversation |
Sheridan, 2008 | US | Acute—4 hospital cases | Case Series | To understand how lives of family members would have been different if new disclosure practices had been in place when they experience the preventable loss of their loved ones | 4 patient stories | Most of the patients 3/4 did not receive any disclosure at all. They said that had they been told what had happened, how their care could have been different and what they would do so that it would never happen again—they would have greatly appreciated and reduced their anger and grief. Major themes quality of communication |
Sorensen, 2010 [22] | Australia | Acute—21 hospitals and health services in 4 Australian sites | Qualitative research | To understand patient's and health professionals' experience of OD and how practice can inform policy | 15 patients and 8 family members | Patients and family members highlighted the biggest problem is that no one had asked what the patient or family wanted, and the absence of feedback or remedy made patients feel not reassured that the adverse event would not happen again making their suffering even more meaningless. Major themes—timeliness of disclosure, quality of communication, importance of accommodating patient/family support needs, and OD as a future oriented conversation |
Walton, 2019 [6] | Australia | Acute | Mix method research | To determine the frequency with which patients who report an adverse event had information disclosed to them about the incident | A cross-sectional survey on patient experiences of disclosure (not a validated survey) related to adverse events was conducted among a random sample of hospitalized patients in NSW, Australia, with responses from 7661 people, including 474 who reported an adverse event | Positive aspects of open disclosure were found to be the human approach, openness and honesty and reciprocal resolution. Negative experiences were when there was a lack of open disclosure process, inadequate implementation of open disclosure and non-responsive staff. Major themes—quality of communication, importance of accommodating patient/family support needs |