Review of disclosure and apology literature: Gaps and needs

Abstract

A review of the literature related to the disclosure movement was conducted to find gaps and needs while identifying areas where needs are being met. There are several articles that address claims and other economic factors. Moreover, there are many papers that define barriers to disclosure with suggested workarounds. There is also a wealth of training content that teaches how to say “sorry.” However, gaps and needs were identified. The “gap list” was developed with a focus on concepts that are novel or not mentioned in the literature as well as issues in the disclosure movement that would benefit from greater attention: (1) lack of research and disclosure training content for health care professionals beyond acute care; (2) messaging and disclosure programs, including the meaning of “apology”; (3) insufficient integration between disclosure programs and second victim support programs; (4) confidentiality clauses; (5) the National Practitioner Data Bank and state licensure boards being viewed as an impediment to disclosure; (6) understanding awareness of the disclosure movement by consumers, personal injury bar, and payors; (7) measuring what medical and nursing schools are teaching about disclosure; and (8) encouraging states to pass apology laws that support the development of disclosure programs.

How will state medical boards handle cases involving disclosure and apology for medical errors?

“…Finally, the survey did not evaluate how limited resources (funding, staff) faced by some state medical boards may impact thinking and decisions regarding disclosure and apology. Indeed, fear of under-resourced state medical boards viewing disclosing/apologizing physicians as easy targets is a part of the reported hesitancy for transparency post event, [1][2][3][4] yet the responses from the boards that responded to this study did not indicate this is a valid concern. Nonetheless, future research could involve interviews and review specific cases along with attempting to query the nonresponding boards to acquire a deeper, more granular understanding of the issues presented in this paper.…”

“…The disclosure and apology movement, also sometimes known as CANDOR or communication and resolution programs (CRP), is gaining traction in American healthcare organizations. [1][2][3][4] Disclosure/CRP is becoming the ethically expected response to adverse medical events, including medical errors, however, there are barriers to implementing disclosure/CRP programs and sustaining them. 5 One stumbling block for American physicians is fear of reporting cases and settlements to state medical boards.…”

Measuring the Uptake of Disclosure and Apology Content in the American Medical School Curriculum

“…The patchwork of so-called “apology laws” in American states was not taken into consideration in the design of this experiment, as many disclosure experts and advocates agree apology laws can offer some encouragement with the development of disclosure programs but said laws are not necessary for successful administration of disclosure programs. 1 …”

“…There has been no measurement or survey about what is being taught about disclosure/CRP in American medical schools. 1 To learn what is being taught about disclosure/CRP in the medical school curriculum, this first-of-a-kind study surveyed deans and curriculum leaders of America's 178 medical schools (Medical Doctor & Doctor of Osteopathic Medicine) on this topic. A survey was also sent to a commercial list of fourth year American medical students.…”

Reviewing recordings of neonatal resuscitation with parents

“…Parents also reported appreciation of the openness of providers about provided care and that this openness and transparency would make them less likely to hold providers responsible for medical errors, a mechanism that is confirmed by studies about disclosing medical errors. 27 As such, reviewing recordings of neonatal resuscitation with parents can be valuable for parental coping and can enhance the parentprovider relationship.…”